Lantieri L, Serra M, Dallaserra M, Baruch J
Service de Chirurgie Plastique, CHU Henri-Mondor, Créteil.
Ann Chir Plast Esthet. 1997 Apr;42(2):156-9.
The advantages of TRAM (Transverse Rectus Abdominus Muscle) flap for breast reconstruction is now well recognised. This technique allows a cosmetic reconstruction with a more natural shape than with conventional reconstruction with prosthesis. However the disadvantage is the need of removal of part or all rectus abdominis muscle. If the techniques of free flap are now recognised to be more reliable than pedicle TRAM they have not demonstrate a superiority in term of parietal sequellae. To avoid such problem some teams have progressively developed the DIEP (Deep Inferior Epigastric Peforator Flap). This flap is harvested only on the transmuscular perforators. We are presenting here our expertise which progressively has leed us from free partial TRAM to DIEP. From december 1995 to january 1997 we have practice 18 breast reconstructions with free flap. On 13 DIEP we had only one parietal complication due to incomplete closing of the aponeurosis at the lowest part of the surgical approach. This complication was easily corrected as the muscle was still tonic. On 5 TRAM, clinical examination finds parietal weakness on 3 cases. We believe that this technique is full of promises as it brings autologous tissue with no complication on donor site.
横行腹直肌肌皮瓣（TRAM）用于乳房重建的优势如今已得到广泛认可。与传统的假体乳房重建相比，该技术能够实现更自然形态的美容性乳房重建。然而，其缺点是需要切除部分或全部腹直肌。尽管目前认为游离皮瓣技术比带蒂TRAM更可靠，但在腹壁后遗症方面，游离皮瓣技术并未显示出优势。为避免此类问题，一些团队逐渐开发了腹壁下动脉穿支皮瓣（DIEP）。这种皮瓣仅通过肌肉穿支获取。在此，我们介绍我们的专业经验，即如何逐步从游离部分TRAM过渡到DIEP。从1995年12月至1997年1月，我们采用游离皮瓣进行了18例乳房重建手术。在13例DIEP手术中，仅因手术切口最低部位的腱膜闭合不全出现了1例腹壁并发症。由于肌肉仍有张力，该并发症很容易得到纠正。在5例TRAM手术中，临床检查发现3例存在腹壁无力情况。我们认为这项技术前景广阔，因为它能提供自体组织，且供区无并发症。
