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腹直肌肌皮瓣与扩张器/植入物联合用于乳房重建。

The combined use of the TRAM and expanders/implants in breast reconstruction.

作者信息

Serletti J M, Moran S L

机构信息

Division of Plastic Surgery, University of Rochester Medical Center, NY 14642, USA.

出版信息

Ann Plast Surg. 1998 May;40(5):510-4. doi: 10.1097/00000637-199805000-00012.

Abstract

The transverse rectus abdominis musculocutaneous (TRAM) flap has replaced the prosthetic implant as the first choice for breast reconstruction. However, we have found several incidences when the volume of autogenous tissue cannot fulfill the requirements for symmetry, especially in those patients with limited abdominal tissue and large ptotic breasts. The TRAM flap can be combined with tissue expanders and implants to obtain symmetry in these difficult reconstructive situations. Here we present our experience with the use of the TRAM flap in conjunction with expanders and saline implants. Between June 1993 and November 1996, 4 patients underwent immediate TRAM reconstruction in conjunction with saline implants or tissue expanders. In 3 patients a tissue expander was placed beneath the pectoralis muscle following the microanastomoses and prior to insetting the flap. Expansion was initiated 2 to 6 weeks postoperatively and continued over a period of 1 to 3 months. Permanent implants were placed at 3 to 4 months following the initial procedure. The final patient underwent a bilateral free TRAM with the placement of bilateral saline implants at the time of the initial reconstruction. One implant was placed beneath the pectoralis whereas the other was placed beneath the TRAM flap. Saline implants were used in all patients. The decision to use the combination of implants and TRAM flap was multifactorial and included position of donor scar in all patients, large ptotic breasts in 2 patients, request for contralateral augmentation in 2 patients, and an absence of adequate abdominal tissue in all patients. In addition, large skin deficits were present in 3 patients following mastectomy requiring the skin coverage provided by the TRAM flap. The average age of the patients was 41 years. Expanders were left in place for an average of 16 weeks. Average final implant volume was 210 cc. The average follow-up was 24 months, during which time there were no episodes of flap compromise, partial flap loss, or fat necrosis. The TRAM flap in combination with tissue expansion and implants provides an additional alternative in postmastectomy reconstruction. This technique is particularly useful in those patients in whom the need for TRAM skin coverage is combined with inadequate autogenous tissue and the patient request for large ptotic breasts.

摘要

腹直肌横形肌皮瓣(TRAM瓣)已取代假体植入,成为乳房重建的首选方法。然而,我们发现有几例自体组织量无法满足对称要求的情况,尤其是那些腹部组织有限且乳房下垂严重的患者。在这些复杂的重建情况下,TRAM瓣可与组织扩张器和植入物联合使用以实现对称。在此,我们介绍我们使用TRAM瓣联合扩张器和盐水植入物的经验。1993年6月至1996年11月期间,4例患者接受了即刻TRAM重建联合盐水植入物或组织扩张器。3例患者在进行微血管吻合后、皮瓣植入前,将组织扩张器置于胸大肌下方。术后2至6周开始扩张,持续1至3个月。初次手术后3至4个月植入永久性植入物。最后1例患者在初次重建时接受了双侧游离TRAM瓣并双侧植入盐水植入物。一个植入物置于胸大肌下方,另一个置于TRAM瓣下方。所有患者均使用盐水植入物。决定联合使用植入物和TRAM瓣是多因素的,包括所有患者供区瘢痕的位置、2例患者乳房下垂严重、2例患者要求对侧增大以及所有患者腹部组织不足。此外,3例患者乳房切除术后存在大面积皮肤缺损,需要TRAM瓣提供皮肤覆盖。患者的平均年龄为41岁。扩张器平均留置16周。最终植入物的平均体积为210立方厘米。平均随访24个月,在此期间未发生皮瓣受损、部分皮瓣丢失或脂肪坏死。TRAM瓣联合组织扩张和植入物为乳房切除术后重建提供了另一种选择。该技术在那些既需要TRAM瓣覆盖皮肤又自体组织不足且患者要求乳房下垂严重的患者中特别有用。

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