带蒂腹直肌皮瓣在乳房重建手术中的应用

随着人民生活水平的提高和医学技术的发展，乳腺癌患者接受全乳切除术后对乳房重建的需求日益增长。带蒂腹直肌皮瓣(transverse rectus abdominis muscle，TRAM)手术是重要的自体组织乳房重建方法。该文就TRAM皮瓣的解剖与血供、TRAM手术的适应证和禁忌证、手术步骤以及并发症进行介绍，同时还对TRAM手术中的一些细节问题进行了探讨。TRAM术式作为自体组织乳房重建技术，不需要假体，从而避免了假体相关的并发症。另外相比于假体重建，自体组织重建的外形和柔软度都更接近于自然乳房，具有更好的重建效果。同时带蒂的TRAM术式不需要显微血管吻合技术和密切的术后皮瓣检测，容易被外科医师掌握并在更多的医学中心开展。因此TRAM皮瓣仍然具有一定的应用前景。

Application of pedicled transverse rectus abdominis muscle flap in breast reconstruction surgery

With the improving of people's living quality and medical technology, the demand for breast reconstruction after mastectomy is increasing. Transverse rectus abdominis muscle (TRAM) surgery is an important way of autologous tissue breast reconstruction. This article introduced the anatomy and blood supply of TRAM flap, the indications and contraindications of TRAM surgery, procedure and complications of the surgery. This article also discussed some problems in surgery. TRAM reconstruction, as a way of autologous tissue reconstruction, can avoid the implant related complications because the implant is not used in the surgery. In addition, compared to the implant recon-struction, the appearance and softness of autologous tissue reconstruction are closer to natural breasts, and the result of this surgery is better. In the meantime, pedicled TRAM reconstruction, which does not need microvascular anastomosis technique and close postoperative monitoring of the flap, is easy to be mastered by surgeons and could be performed at more medical centers. Therefore, the TRAM flap still has its own application prospect.