Extensive Post-mastectomy Chest Defects Reconstructed with Pedicled Transverse Rectus Abdominis Myocutaneous Flap

以橫向腹直肌肌皮瓣覆蓋侵犯性乳癌之切除後巨大缺損

楊育莉(Yu-Li Yang) ； 林幸道(Sin-Daw Lin) ； 劉家銘(Chia-Ming Liu) ； 候明峰(Ming-Feng Hou) ； 賴春生(Cheng-Sheng Lai)

《中華民國整形外科醫學會雜誌》 12卷1期 (2003/03) Pp. 43-49

https://doi.org/10.7096/JPSA.200303.0043

摘要

對於侵犯性乳癌之手術治療，目前仍有爭議。輔助性化療，乳房切除，術後化療，放射線治療的合併治療可改善病人存活率。無論如何，乳房切除後的巨大缺損對整形外科醫師仍是一大挑戰。對於前胸壁缺損，使用胸大肌皮瓣，闊背肌皮瓣，腹直肌皮瓣，大網膜皮瓣合併植皮，腹外斜肌皮瓣，擴張性V-Y闊背肌皮瓣，均有人報告過。
本篇報告提出四個有大面積病灶之侵犯性乳癌病人，成功以橫向腹直肌肌皮瓣覆蓋缺損。此四個病人均無重大合併症且皮瓣存活。使用橫向腹直肌肌皮瓣覆蓋侵犯性乳癌切除後之巨大缺損，有以下優點：足夠的體積，可信賴的組織，較簡單的手術技術，較短的開刀時間。因此，我們認為積極手術對此類病人，不僅是安全的，對局部控制有效的，且改善個人衛生，增加病患的生活品質。

並列摘要

Surgical management of advanced breast carcinoma is controversial. It has been suggested that multimodality treatment, including neoadjuvant chemotherapy, mastectomy, post-operative chemotherapy, and radiotherapy, improves survival rate. However, the resulting large post-mastectomy defect remains a challenge to the reconstructive surgeon.
This series presents four cases in which large post-mastectomy defects were successfully covered with pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. The average defect area measured 18.3x13.5cm, and the average operation, including excision, lasted 3 hours and 50 minutes. There was an average hospital stay of 11 days. There were no major complications, although minor complications included wound dehiscence in Case 2, and flap edge necrosis in Case 3. These patients received debridement, and their wounds healed after secondary intervention. Two advantages of employing the pedicled TRAM flap for large mastectomy defect reconstruction are that it provides a reliable source of tissue with adequate volume, and it is a shorter, relatively easy surgical procedure. Results of this series suggest that aggressive surgical resection of advanced breast car(superscript -) cinoma and reconstruction with TRAM flap are safe and effective, and that this approach enhances quality of life and social activity because of the resulting improvement in personal hygiene.

並列關鍵字

TRAM flap ； post-mastectomy defect ； advanced breast cancer