乳腺癌术后游离腹直肌肌皮瓣乳房再造

目的 评估乳腺癌术后游离横向腹直肌肌皮瓣（transverse rectus abdominis myocutaneousflap,TRAM）再造乳房的近期疗效.方法 2003年7至11月期间,我们在美国得克萨斯州大学圣安东尼奥科学健康中心整形重建外科共进行乳腺癌术后游离TRAM皮瓣再造乳房12例,平均年龄43.5岁,平均体重68.6kg,其中乳腺癌术后一期乳房再造2例（16.7%）、延期再造10例（83.3%）,游离皮瓣的血管蒂为对侧腹壁下动静脉,12例患者中选择胸背血管为受区血管的2例、选用胸廓内动静脉为受区血管的10例,再造手术后平均随防时间2.8个月.结果 12例游离TRAM皮瓣再造乳房手术皆顺利完成,手术成功率100%,平均手术时间8.3 h,平均住院时间9.4 d,为了对称行对侧乳房缩小术5例（41.7%）.共发生并发症3例6例次,并发症发生率25%,并发症包括皮下积液积血3例次（50%）、创口延迟愈合2例次（33.3%）,再造乳房部分脂肪坏死1例次（16.7%）,未见皮瓣坏死、腹壁疝、腹部皮肤坏死、创口感染等严重并发症的发生.患者自我评价对再造乳房总体满意者11例（91.7%）,不太满意者1例（8.3%）,无一例患者不满意.结论 乳腺癌术后游离TRAM皮瓣再造乳房安全可靠、整形效果良好,患者对重建的乳房有着较高的满意度.

Breast reconstruction using free transverse rectus abdominis myocutaneous flap after resection of breast cancer

Objective To evaluate the early outcomes of breast reconstruction with free transverse rectus abdominis myocutaneous(TRAM)flaps after resection of breast cancer. Methods A total of 12 free TRAM flaps were performed after breast cancer surgery in The University of Texas Health Science Center at San Antonio from July 2003 to November 2003.Average patient age was 43.5 years, and average weight was 68.6 kg. Reconstruction was undertaken as an immediate procedure after mastectomy in two patients (16.7%) and as a delayed procedure in 10 patients (83.3%). The flap was harvested based on the deep inferior epigastric vessel on the opposite side to the affected breast. Of the 12 patients, 2 patients underwent reconstruction using the thoracodorsal vessels and 10 patients underwent reconstruction using the internal mammary vessels as the receipt vessels. Mean follow-up time was 2.8 months. The surgical technique, complications and the early results of breast reconstruction are reported. Results The free TRAM flap Reconstruction was successfully performed in all patients at a success rate of 100%. Average operating time was 495 minutes, and average hospital stay was 9.4 days. The contralateral breast reduction was performed in 5 (41.7%) of the patients. Six complications occurred in 3 of 12 reconstructions (25%). Complications included three haematoma or seroma formation, two delayed wound healing and one partial fat necrosis. There were no major postoperative complications such as partial flap loss, total flap loss, wound infection or abdominal wall hernia. Results were considered extremely satisfactory or satisfactory in 11 cases (91.7%), less satisfactory in one case(8.3%). No case was dissatisfied with her reconstruction. Conclusions This study suggests that the free TRAM flap for breast reconstruction is a safe and reliable technique which provides an excellent cosmetic outcome with a high degree of patient satisfaction. ;