乳腺癌术后单蒂横行腹直肌肌皮瓣乳房再造

目的：探讨下腹部单蒂横行腹直肌肌皮瓣（Transverse Rectus Abdomials Myocataneous，TRAM）在乳腺癌术后乳房再造中的应用。方法：2004～2007年，对13例乳腺癌患者应用对侧单蒂TRAM皮瓣进行乳房再造，其中Ⅰ期再造7例，Ⅱ期再造6例，乳腺癌根治术后1例，乳腺癌改良根治术后12例。1例Ⅱ期进行乳头乳晕再造。9例供区下腹部应用涤纶补片加强腹壁预防腹壁软弱和腹壁疝形成。结果：2例Ⅱ期再造术后TRAM皮瓣小部分坏死，1例Ⅱ期再造术后TRAM皮瓣部分皮下脂肪硬结伴部分液化，1例对侧下腹壁轻度膨隆不适，无腹壁疝。结论：乳腺癌术后应用单蒂TRAM皮瓣乳房再造术是一种较为有效、简单和安全的方法，应用涤纶补片加强腹壁可以有效预防腹壁软弱和腹壁疝形成。

Breast Reconstruction with Transverse Rectus Abdomials Myocataneous(TRAM) flap after mastectomy for breast cancer

Objective To explore the application of a Transverse Rectus Abdomials Myocataneous (TRAM) flap in breast reconstruction after mastectomy for breast cancer. Methods From 2004 to 2007,there were 13 patients received breast reconstruction after mastectomy with TRAM flap, 7 of these cases received immediate breast reconstruction and 6 of them received delayed breast reconstruction. Among the 13 cases, 1 case received radical mastectomy and 12 cases received modified radical mastectomy. Among them,there was 1 case added to perform nipple -areola reconstruction and there were 9 cases added to strengthen abdominal wall in donor site of bythus with dacron patch to prevent flabbiness and lateral ventral syndrome. Results There were 2 cases combined with partial flap necrosis after delayed breast reconstruction. 1 cases with partial subcutaneous fat induration and fat colliquation of TRAM. 1 case combined with bythus bulge in opposite side instand lateral ventral syndrome. Conclusion It is an effective and safe method in breast reconstruction with TRAM flap after mastectomy for breast cancer.And it is an effective approach to prevent flabbiness and lateral ventral syndrome by dacron patch.