腹壁下动脉穿支横行下腹部皮瓣游离移植乳房再造

目的 对下腹部横行腹直肌(TRAM)肌皮瓣的术式进行改进和完善，从而避免腹部并发症，扩大皮瓣的临床应用范围。方法 TRAM瓣改进为保留腹直肌及其前鞘，分离出腹壁下动脉穿支横行下腹部皮瓣(DIEP)，用于21例乳房再造。结果 20例双侧腹壁下动脉的双蒂穿支皮瓣病例全部成活；1例仅保留单侧穿支的皮瓣远端出现缺血现象。随访5月～3年，再造乳房外形满意，未见腹壁薄弱、腹疝等腹部并发症发生。下腹供区疤痕隐蔽，同时也达到了腹壁整形减肥的效果。结论 移植横行下腹部DIEP瓣再造乳房，供区损伤小，组织量充足，血供丰富，是目前最为理想的手术方法。DIEP瓣也能根据需要修复多种软组织缺损，因保留了腹直肌及其前鞘，对供区的创伤最小，对肥胖者还能起到腹壁整形的作用。该皮瓣的应用代表了整形外科的发展方向。

Breast reconstruction with deep inferior epigastric perforator transverse inferiorabdominis flap

Objective Based on anatomie studies, we improved the techniques of harvesting the free inferior epi-gastric artery-transverse rectus abdominis myocutaneous ( TRAM ) flap as the deep inferior epigastric perforator ( DIEP) flap in order to avoid morbidity of the former's donor site due to harvesting of some or all of the rectus muscle and to expand its clinical applications. Methods We performed breast reconstruction for one patient after mastec-tomy with this DIEP flap, sparing the whole rectus abdominis muscle, and therefore, preserved adequate competence of the abdominal wall. Results This flap has all the advantages inherent in TRAM flap breast reconstruction and the donor site morbidities were avoided. The variety of the dimension and thickness of the flap and the length of its pedicle increase its flexibility in clinical applications. Conclusion DIEP flap can repair various defects as re-quired. Because it spares the whole rectus abdominis muscle, it has minimal insult to the abdominal wall and has ab-dominoplastic effects for middle-aged women. The applications of this kind of flap represent the direction of develop-ment in plastic surgery.