应用下腹部横行腹直肌肌皮瓣的乳房再造

目的 安全应用下腹部横形腹直肌肌皮瓣（TRAM）进行乳房再造。方法 总结42例乳房再造的经验，详尽介绍了病例选择，皮瓣设计和手术方法。结果 应用TRAM再造乳房42例，其中即时再造25例，后期再造17例；单蒂TRAM35例，双蒂TRAM7例，单蒂中有7例附加血管吻合。2例术后腹部供区皮瓣部分坏死，2例TRAM部分坏死，1例双蒂皮瓣术后腹壁疝形成。结论 附加血管吻合或选用双蒂肌皮瓣，以及肌肉内分离是减少并发症的重要措施。

Breast reconstruction with a TRAM flap

Objective Breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap was performed to enhance the mental and physical well-being of patients. Methods The experience with TRAM breast reconstruction in 42 patients was reviewed. The patient selection, flap design and our operative technique were introduced in detail. Results TRAM breast reconstruction was performed as immediate reconstruction in 25 patients, as delayed reconstruction in 17 cases. 2 cases had partial skin necrosis in the abdominal donor site. 2 had partial necrosis of the TRAM flap. One patient had abdominal hernia. Conclusions The additional vascular anastomosis or double pedicle TRAM flap with intramuscular dissection was the key points to reduce complications. Due to the difficulty of TRAM flap reconstruction, thorough understanding of the technique and surgical accuracy are necessary for both flap safety and aesthetic pleasing results.