Alexandrides I J, Shestak K C, Noone R B
Division of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine, PA, USA.
Ann Plast Surg. 1997 Apr;38(4):335-41. doi: 10.1097/00000637-199704000-00005.
Following transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction there are predictable sensory changes in both the abdominal skin and the skin of the reconstructed breast. Cutaneous anesthesia and dysesthesias are troublesome and annoying for many patients. More importantly, these sensory changes can lead to burn injury in the uninformed patient. Over the past 9 years 5 of our patients have sustained third-degree burn injuries to the skin following breast reconstruction with the TRAM flap. Four of these occurred while sunbathing while wearing a black bathing suit and one was the result of a direct thermal injury. Two patients sustained injuries to the breast, 2 patients experienced injuries to the abdomen, and 1 patient experienced injuries to both sites. All of these untoward events occurred within the initial 4 months following surgery. Four patients healed with topical wound treatment but 1 patient required a full-thickness skin graft to optimize cosmesis of the reconstructed breast. Patient examples illustrating burn injuries and treatment outcomes are shown. Mechanisms involved are sensory and thermoregulatory loss locally at the anterior abdominal wall and at the reconstructed breast. The reinnervation potential according to experimental and clinical studies is reviewed. There are sensory and thermoregulatory changes in the skin at the donor and recipient site during TRAM flap breast reconstruction. Patients should be carefully informed about these and warned to avoid prolonged contact with hot objects and sun exposure, especially when wearing a dark-colored swimsuit.
在横行腹直肌肌皮瓣（TRAM瓣）乳房重建术后，腹部皮肤和重建乳房的皮肤会出现可预测的感觉变化。皮肤麻醉和感觉异常对许多患者来说既麻烦又恼人。更重要的是，这些感觉变化可能导致不知情的患者发生烧伤。在过去9年中，我们有5例患者在采用TRAM瓣进行乳房重建后皮肤遭受了三度烧伤。其中4例发生在穿黑色泳衣日光浴时，1例是直接热损伤的结果。2例患者乳房受伤，2例患者腹部受伤，1例患者两个部位均受伤。所有这些不良事件均发生在手术后的最初4个月内。4例患者经局部伤口治疗愈合，但1例患者需要进行全层皮肤移植以优化重建乳房的美观。文中展示了说明烧伤及治疗结果的患者实例。所涉及的机制是前腹壁和重建乳房局部的感觉和体温调节丧失。根据实验和临床研究对再支配潜力进行了综述。在TRAM瓣乳房重建过程中，供区和受区皮肤存在感觉和体温调节变化。应仔细告知患者这些情况，并警告他们避免长时间接触热物体和阳光照射，尤其是穿深色泳衣时。
