Hein K D, Morris D J, Goldwyn R M, Kolker A
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass 02215, USA.
Plast Reconstr Surg. 1998 Dec;102(7):2287-92. doi: 10.1097/00006534-199812000-00001.
To find an alternative to synthetic mesh closure of abdominal fascial defects after transverse rectus abdominis musculocutaneous (TRAM) flap harvest, dermal autografts were removed from tissue to be discarded and used for fascial closure. Dermal grafts have been used for herniorrhaphy and fascial repair after TRAM harvest previously, but have never been systematically studied. The dermal autograft technique was used in 24 patients to repair or reinforce anterior rectus sheath or external oblique fascia after TRAM harvest for breast reconstruction. During the same period, 25 other patients underwent TRAM breast reconstruction with abdominal wall closure by other methods. All patients were followed by serial physical examinations given by the operating surgeon. Average follow-up in the dermal autograft group was 12.6 versus 12.0 months in the second group. In the dermal autograft group, two patients complained of bulging of the anterior abdominal wall; one developed a true hernia, away from the location of the dermal autograft. In the second group, two patients experienced bulging. Wounds and infectious complications were similar in both groups. Dermal autografts are a useful alternative to mesh repair or direct closure of fascial defects after TRAM flap harvest.
为了找到腹直肌肌皮瓣（TRAM）切取术后腹壁筋膜缺损的合成补片闭合替代方法，从拟丢弃的组织中获取自体真皮移植物用于筋膜闭合。自体真皮移植物此前已用于TRAM切取术后的疝修补和筋膜修复，但从未进行过系统研究。24例患者在TRAM切取用于乳房重建后，采用自体真皮移植物技术修复或加固腹直肌前鞘或腹外斜肌腱膜。同期，另外25例患者采用其他方法闭合腹壁行TRAM乳房重建。所有患者均由主刀医生进行系列体格检查随访。自体真皮移植物组平均随访12.6个月，第二组为12.0个月。自体真皮移植物组有2例患者主诉前腹壁膨隆；1例出现真性疝，位于远离自体真皮移植物的部位。第二组有2例患者出现膨隆。两组的伤口及感染并发症相似。自体真皮移植物可作为TRAM皮瓣切取术后补片修复或直接闭合筋膜缺损的有用替代方法。
