三叶状下腹部腹直肌肌皮瓣乳房重建

目的 用改善血供的下腹部械行腹直肌肌皮瓣（ＴＲＡＭＦ）重建乳房。方法 在通常以上部腹直肌为蒂的ＴＲＡＭＦ的肌蒂表面附加一块脐旁三角形皮瓣，使共同组成三叶状，藉以增加同皮穿支动脉的血供及肌皮瓣提供的组织量，便于乳房塑形和腋部瘢痕挛缩的充分松解修复，以及胸壁的的放射性烧伤创面的修复。结果 乳癌术后单侧乳房缺失伴胸壁放射性溃疡及腋部瘢痕挛缩６例，肌皮瓣完全成活者４例，皮瓣最远端少量坏死及脂肪液化者２例。

Breast reconstruction using pedicled three-lobe transverse rectus abdominis musculocutaneous flap]

OBJECTIVE: An innovated transverse rectus abdominis musculocutaneous flap, the three-lobe TRAM flap was designed for breast reconstruction. METHODS: A triangle-shaped skin over the upper part of the rectus abdominis muscle was included in the conventional TRAM flap for the purpose of adding more skin for breast reconstruction and enhancing blood supply of the skin portion of the TRAM flap. RESULTS: In this group of six patients subjected to mastectomy and radiation therapy for breast cancer, complete survival of the three-lobe TRAM flap was obtained in 4 cases. Two patients had minor skin necrosis and fat liquefaction. Better breast contour and contracture release of the axilla were also achieved. CONCLUSION: This innovation of conventional TRAM flap for breast reconstruction has some advantages. It is especially useful for patients complicated with radiation lesions on the chest and axilla areas.