上、下蒂横形腹直肌肌皮瓣乳房再造的解剖学研究

目的探讨上蒂横形腹直肌肌皮瓣乳房再造术后并发症产生的原因。方法对20侧成人尸体进行解剖观察。结果发现主要是由于上蒂术式切断了该肌皮瓣的主要供血动脉——腹壁下动脉,仅靠腹壁上、下动脉之间微薄的螺旋微动脉的吻合支供血,以致术后产生脂肪液化、边缘坏死等并发症。结论腹壁下动、静脉是中、下腹部横形腹直肌肌皮瓣的直接供血动脉及回流静脉,即下蒂优于上蒂。

An anatomic study on the superiorly and inferiorly based TRAM flap in breast reconstruction

Objective The aim of the work was to study the reason for complications of breast reconstruction using a superiorly based TRAM flap. Methods An anatomic study was carried out on 10 cadavers of 20 sides. Results It was found that the main factor causing complications, i, e. fat necrosis and/or tissue loss, after breast reconstruction by transferring the transverse rectus abdominis museulo- cutaneous (TRAM) flap based on superior epigastric vessels ,was that the dominant artery (the inferior epigastric artery) was divided. The survival of the superiorly based TRAM only depended on the vascu- lar supply from a few "choke anastomosis system" between the SEA and the IEA. Conclusion TRAM flap transferring for breast reconstruction can not only depend on the superior pedicle.