Basic Study Of Muscle Sparing TRAM Flap And Its Clinical Application On Ⅰ Stage Of Breast Reconstruction After Surgery Of Breast Cancer

ObjectiveTo dissect the full-length of inferior epigastric artery, and observe its route andthe location relationship with rectus abdominis. Understand the parameters of inferiorepigastric artery related to its anatomy with ultrasound, and to explore the secondarysignificance of ultrasound at the use of clinical breast reconstruction, and to providethe basis information for the breast reconstruction after surgery of breast cancer.Based on the results of anatomy, and then explore the feasibility and results of breastreconstruction on clinical.Methods1.5cases of chinese adult femae cadavers fixed by10%formalin, injectemedical red latex from the starting point of inferior epigastric artery. Dissect thefull-length of this artery, and then watch and record its route, branches and scope ofsupply. Check up the inferior epigastric artery of health adult female with colordoppler ultrasonoscope, observe the number of its branch, measure the diameter andthe blood flow parameters at the point of starting. Give statistical analysis of all thedata at last.2. Based on the results of anatomy, and understand the effect of breastreconstruction.Results1. Results of anatomy(1) The fall length of inferior epigastric artery of cadavers is (8.28±0.27)cm.The external diameter at the starting point of external iliac artery is (2.35±0.14)mm,and the distance from here to deep inguinal ring is (1.13±0.22)cm, to superficialinguinal ring is (3.75±0.41)cm,，and the area supply by the artery is (153.40±23.25)cm2. (2) The number of branches issued by inferior epigastric artery is from7to18,and the average number is (12.3±2.83).The external diameter of Deep inferiorepigastric perforator is (1.56±0.12)mm.(3) Exposing the full rectus abdominis，and separating the rectus abdominisfollowing its musle direction at the middle of rectus abdominis, and detecting thesituation of injured vessel. At the10inferior epigastric artery of5cadavers,2casesare equal at the diameter of inside and outside branch, and the rest ones are at thesame situation that the diameter of the inside brench is larger than the outside one.2. Results of ultrasound(1) For the64inferior epigastric arteries of32patients,7of them starting fromfemoral artery(7/64，10.9%), and the other57starting from external iliacartery(57/64，89.1%).(2)Though the measuring under ultrasound, the average diameter of the startingpoint of left inferior epigastric artery is (1.93±0.54)mm, and the right data is (1.95±0.41) mm. The max blood speed of left and right inferior epigastric artery at systolicare (58±14)cm/s and (59±11)cm/s, and the min blood speed of left and right inferiorepigastric artery at diastolic are (7.1±1.8)cm/s and (6.8±2.0)cm/s. Pulsatilityindex(PI) of bilateral inferior epigastric artery are (2.14±0.7) and (2.18±0.8)，andthe Resistive index(RI) are (0.88±0.32) and (0.89±0.38).3.Breast reconstruction with TRAM flapFrom September2010to July2011, muscle-sparing TRAM flap performed on8patients, and the effect was satisfactory during the following3months to1year.2cases with immediate breast reconstruction appeared fibrosis in some subcutaneousfat of flap Ⅳ area，and2cases with immediate breast reconstruction appearedborderline necrosis and subcutaneous fat liquefaction in minor area of flap Ⅳarea, which healed after debridement latter. Except for1case of breast reconstructionhad a poor shape, the other cases were good. There were no abdominalweakness,hemia and any other discomfort.Conclusion(1) The external diameter of inferior epigastric artery and the number of its branches is constant, and the supply of blood is very rich. As a simple and no-invasiveexamination pattern, ultrasound could provide reliable anatomical information. It issafe and feasible for breast reconstruction with Transverse rectus abdominismusculocutaneous(TRAM) flap or deep inferior epigastric perforator(DIEP) flap inclinical, and careful operation is needed during surgery.(2) It is an effective and safe method in breast reconstruction withmuscle-sparing TRAM flap after mastectomy for breast cancer. Muscle-sparingTRAM flap is an effective approach to decrease the complication of the abdominaldonor site, and the processes of surgery are not time-consuming.