下腹部横行腹直肌肌皮瓣联合腹壁下动脉穿支皮瓣乳房再造术

目的 探讨应用下腹部腹直肌肌皮瓣联合腹壁下动脉穿支皮瓣行乳房再造的手术方法，并分析其适应证。方法 以健侧腹直肌为肌蒂、患侧腹壁下动、静脉穿支为吻合血管蒂形成下腹部横行腹直肌肌皮瓣与腹壁下动脉穿支联合皮瓣，将腹壁下动、静脉与患侧胸背血管或胸廓内血管相吻合，进行乳房再造。结果 自2003年以来，于临床应用17例，所有皮瓣皆成活，随访3～12个月，再造乳房外形满意。结论 下腹部腹直肌肌皮瓣联合腹壁下动脉穿支皮瓣，具有血运可靠、提供组织量丰富、塑形自由度大、供区损伤较小等优点，尤适宜需要移植体积多以及胸廓内血管受损的乳房再造患者。

Breast reconstruction with a combined skin flap of DIEP and TRAM

Objective To evaluate breast reconstruction with a combined skin flap of the deep inferior epigastric perforator(DIEP) and the transverse rectus abdominis musculocutaneous(TRAM). Methods The DIEP and TRAM united flap was elevated with the vessel pedicle of the deep inferior epigastric perforator on the affected side and the rectus abdominis muscle pedicle on the intact side.The reconstructive breast was shaped after the deep inferior epigastric vessels were anastomosed to the internal mammary vessels or the thoracodorsal vessels ipsilaterally. Results We have used the DIEP and TRAM united flaps for breast reconstruction in 17 cases.All of the flaps survived,and the reconstructed breasts were well-shaped with the follow-up of 6-18 months. Conclusions The DIEP and TRAM united flap possesses of advantages such as rich blood supply,abundant tissue volume and easy shaping.It is especially applicable to the cases who have large chest defect and need large volume tissue.