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目的:探索腹壁下血管术前预切断行带蒂腹直肌皮瓣(TRAM)乳房再造的临床效果和手术并发症。方法:6例乳腺癌病例入组,术前预切断带蒂侧腹壁下血管、10~14d后行TRAM乳房再造术。彩超测定带蒂侧腹壁上动脉阻力指数、血管内径等在预切断术前后的差异,评估皮瓣血供、美容、并发症。结果:6例患者再造术后皮瓣均存活,腹壁上动脉阻力指数降低,内径增加,局限性脂肪坏死1例,未出现皮瓣坏死、腹壁并发症。术后随访7~23个月,均为无病生存。结论:腹壁下血管预切断后再行TRAM乳房再造,可改善带蒂皮瓣的腹壁上动静脉血供,再造乳房形态优良,并发症少见。
Objective: To explore the clinical effects and surgical complications of transabdominal rectus abdominis flaps (TRAM) underwent resection of the abdominal wall prior to surgery. Methods: Six cases of breast cancer were enrolled in the study. The pedicled inferior abdominal wall vessels were pre-severed preoperatively and TRAM breast reconstruction was performed 10 to 14 days later. Color Doppler ultrasound on the pedicel side of the abdominal artery resistance index, vascular diameter and other preoperative and postoperative differences in the assessment of flap blood supply, beauty, complications. Results: All the flaps survived in 6 cases after reconstruction. The resistance index of the upper abdominal artery decreased, the diameter increased, and 1 case had localized fat necrosis. No flap necrosis or abdominal wall complications occurred. All the patients were followed up for 7 to 23 months. All were disease-free survival. CONCLUSION: TRAM breast reconstruction can be performed after pre-subcutaneous abdominal blood vessel resection, which can improve the blood supply of arteriovenous and venous blood on the abdominal wall of pedicled skin flap. The breast reconstruction is rare and the complications are rare.