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目的评估乳腺癌术后游离横向腹直肌肌皮瓣(transverserectusabdominismyocutaneousflap,TRAM)再造乳房的近期疗效。方法2003年7至11月期间,我们在美国得克萨斯州大学圣安东尼奥科学健康中心整形重建外科共进行乳腺癌术后游离TRAM皮瓣再造乳房12例,平均年龄43.5岁,平均体重68.6kg,其中乳腺癌术后一期乳房再造2例(16.7%)、延期再造10例(83.3%),游离皮瓣的血管蒂为对侧腹壁下动静脉,12例患者中选择胸背血管为受区血管的2例、选用胸廓内动静脉为受区血管的10例,再造手术后平均随防时间2.8个月。结果12例游离TRAM皮瓣再造乳房手术皆顺利完成,手术成功率100%,平均手术时间8.3h,平均住院时间9.4d,为了对称行对侧乳房缩小术5例(41.7%)。共发生并发症3例6例次,并发症发生率25%,并发症包括皮下积液积血3例次(50%)、创口延迟愈合2例次(33.3%),再造乳房部分脂肪坏死1例次(16.7%),未见皮瓣坏死、腹壁疝、腹部皮肤坏死、创口感染等严重并发症的发生。患者自我评价对再造乳房总体满意者11例(91.7%),不太满意者1例(8.3%),无一例患者不满意。结论乳腺癌术后游离TRAM皮瓣再造乳房安全可靠、整形效果良好,患者对重建的乳房有着较高的满意度。
Objective To evaluate the short-term efficacy of transrectal transverse rectus abdominis muscle flap (TRAM) in breast reconstruction after breast cancer surgery. Methods From July to November 2003, we performed 12 cases of reconstructive breast reconstruction with free TRAM flap after breast cancer surgery in the Department of Plastic Surgery, San Antonio Scientific and Health Center, University of Texas, San Francisco, United States. The average age was 43.5 years and the average body weight was 68.6 kg. Breast cancer Two cases (16.7%) were rebuilt after operation, 10 cases (83.3%) were deferred, and the flap of the free flap was the contralateral abdominal artery and veins. The thoracodorsal vessels were selected in 12 cases Cases, the selection of the thoracic artery and vein for the affected area of the vessel in 10 cases, after an average of reconstruction surgery with anti-time 2.8 months. Results All 12 cases underwent TRAM flap reconstruction successfully. The successful rate of operation was 100%. The average operation time was 8.3 hours and the average length of hospital stay was 9.4 days. Five cases (41.7%) contracted breast contractions. Complications occurred in 3 cases in 6 cases, the complication rate was 25%. Complications included subcutaneous fluid hemorrhage in 3 cases (50%), delayed wound healing in 2 cases (33.3%), partial reconstruction of breast fat necrosis Cases (16.7%), no skin flap necrosis, abdominal hernia, abdominal skin necrosis, wound infection and other serious complications. Patient self-evaluation of breast reconstruction in patients with overall satisfaction in 11 cases (91.7%), not satisfied with 1 case (8.3%), none of the patients are not satisfied. Conclusion The postoperative free TRAM flap for breast cancer is safe and reliable, and the shaping effect is good. The patients have high satisfaction with the reconstructed breast.