Transverse rectus abdominis myocutaneous tram flap surgery was developed decades ago and is no longer recommended or performed at the johns hopkins breast center, because of the risk of hernia or abdominal bulge and the limit on lifting anything over 20 pounds post surgery. View and download powerpoint presentations on free flaps ppt. The use of an inferiorly based rectus abdominis myocutaneous flap taken. Pdf rectus abdominis myofascial flap for vaginal reconstruction.
In this publication, he also proposed using this flap for many reconstructive purposes, especially in the head and neck region, as a. Microvascular flap course attendence is limited to max. Rbcp complications in breast reconstruction using a. When performing a rhinoplasty, the hump in the nose is removed. The rectus abdominus myoperitoneal flap for vaginal. Page 2 of 5 your hospital stay after rectus abdominis free flap surgery. Rectus abdominis free flap after uneventful resection of tumor, internal jugular vein and. Seven large defects of the lower torso were closed with rectus abdominis musculocutaneous flaps. Find powerpoint presentations and slides using the power of, find free presentations research about free flaps ppt.
Uwmc otolaryngology head and neck surgery center box 356161 1959 n. Tendinous intersections incriptiones tendinae further subdivide each rectus abdominis muscle into a. However, this flap should be used with caution in the reconstruction of defects of the upper one third of the abdomen due to the relative unreliability of the distal one third of the skin paddle. The first version of the vertical rectus abdominis vram flap for breast reconstruction was reported by drever4 in 1977. Repair of duodenal fistula with rectus abdominis muscle. Transplantation of a transverse rectus abdominis myocutaneous tram flap is a commonly used surgical procedure for breast reconstruction following mastectomy an autologous myocutaneous flap consisting of abdominal skin, subcutaneous fat, the rectus abdominis muscle, and adjoining vasculature is used for reconstruction of the breast following mastectomy. Which of the following is the most likely duration of the global period for this patient. It has been used extensively as both a pedicled and free flap for breast reconstruction. The treatment for breast cancer is primarily surgical, which has a great psychosocial impact on women. You will begin to increase your activity every day. It is very important to have a good blood supply to the free flap tissue so. Reconstruction of complex groin defects with inferior.
The transversus abdominis is the deepest of the three muscles and its fibers run in a horizontal direction. Termed the oblique rectus abdominis musculocutaneous oram flap, this flap variation has significant advantages in terms of ease of dissection and versatility over its flap cousins the vertical rectus abdominis musculocutaneous flap and the transverse rectus abdominis musculocutaneous flap. The paired rectus muscles provide abdominal flexion and support for the intraabdominal contents. General considerations indications with the increased use of the forearm flap for intraoral and pharyngeal reconstruction, the rectus has been relegated to a secondline choice for reconstruction of these areas. Spectrum of normal and abnormal mr imaging findings1 learning objectives for test 3 after reading this article and taking the test, the reader will be able to. Rectus abdominis musculocutaneous flap incision academy. The rectus abdominis musculocutaneous free flap, based on the deep inferior epigastric artery and vein, has been used widely in reconstruction of the breast a. Two years later, drever described a superiorly based rectus abdominis flap with a vertical skin island which he used as a pedicled flap to treat a scar contracture at the chest.
She says she is worried that she might not be able to afford additional followup visits should she be obligated to pay. The purpose of this study was to evaluate the morbidity and results of. Swallowing function before and after subtotal glossectomy. The adequacy of the vascular supply to the fascia was confirmed by us during surgery by the 538 chest wall reconstruction by a rectus abdominis myocutaneous composite flap 539 fig. Maxillary reconstruction using free rectus abdominis myocutaneous flap combined with vascularized costal cartilages. Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are. After the treatment, clean wound and growth of fresh granulation were observed, and the rectus abdominis myocutaneous flap survived and the wound was found to heal well during postoperative follow ups. The rectus abdominis musculocutaneous flap could be collected from the same surgical field, and its preparation as an extended musculocutaneous flap widely beyond the range of the muscle body was possible. The rectus abdominis is a long flat muscle, which extends along the whole length of the front of the abdomen, and is separated from its fellow of the opposite side by the linea alba. Transplantation of a transverse rectus abdominis myocutaneous tram flap is a commonly used surgical procedure for breast reconstruction following mastectomy.
Does the use of an acellular dermal graft in abdominal. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and. When compare the anterior rectus sheath turnover flap with dual mesh, it is obvious that anterior rectus sheath turnover flap is more cost effective. Rectus abdominis flap technique for head and neck reconstruction.
The rectus abdominis musculocutaneous free flap, based on the deep inferior epigastric artery and vein, has been used widely in reconstruction of the breast and extremities. Complications in breast reconstruction using a transverse. Discuss the surgical techniques used in breast reconstruction with both pedicled and free tram. It is a composite flap and comprises muscle, overlying fascia and skin. The rectus abdominis free flap is one of the most versatile softtissue flaps. Reconstruction of abdominal wall defects using extended. Modifications to the standard surgical technique may reduce complications and improve the versatility of this flap. Learn about the rectus abdominis musculocutaneous flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. The number of reports on its applications in the head and neck is limited. In this procedure, an autologous myocutaneous flap consisting of abdominal skin, subcutaneous fat, the rectus abdominis muscle, and adjoining vasculature is used for reconstruction of. External oblique is the most superficial muscle of the anterior abdominal wall. Breast cancer is the leading cause of death in the female population. The rectus abdominis flap is favored for this application because of its ease of harvest and reliability. Experience with 60 inferior rectus abdominis flaps journal of.
It can be harvested as a muscleonly flap or as a myocutaneous flap. Objectiveto present a 1stage technique for orbital reconstruction after exenteration with the use of myocutaneous rectus abdominis free flap in children. The oblique rectus abdominis musculocutaneous flap. We present data from our collective patients to document the benefits of the inferior recurs abdomhris flap and recommend this technique as a safe surgical. The transverse rectus abdominis myocutaneous freeflap, created from the transverse abdominal muscle, is a breast reconstruction flap harvested. Indications with the increased use of the forearm flap for intraoral and pharyngeal reconstruction, the rectus has been relegated to a secondline choice for reconstruction of these areas. This document was downloaded for personal use only. The rectus abdominis muscle flap provides a local option for defects anywhere in the anterior abdominal wall. To reduce this trauma, reconstructive surgery offers different options including the use of a retail transverse rectus abdominis tram flap. By preparing a trilobed flap, the flapdonor region could also be easily closed. New technical approach for the repair of an abdominal wall. Subtotal glossectomy, rectus abdominis musculocutaneous flap, swallowing function, hyoid bone movement, width of the esophageal entrance 1. An important area of weakness that should be recognized when securing abdominal closure after flap harvest.
The superiorly based partial rectus abdominis and external o. Microvascular surgery protocols general considerations. The diep flap utilizes the same lower abdominal skin and fat as the tram and free tram flap. Myocutaneous flaps have been used to improve healing. Reconstruction of complex groin defects with inferior epigastric arterybased rectus abdominis muscle flaps fig. The muscle can be up to 30 cm long and up to 10 centimeters wide.
Recovery after transverse rectus abdominis myocutaneous flap breast reconstruction surgery deena damsky dell, msn, rn, bc, aocn, carolyn weaver, msn, rn, aocn, jeannie kozempel, pt, dpt, ms, and andrea barsevick, phd, rn, aocn purposeobjectives. Case report treatment of sternal osteomyelitis after open. Breast reconstruction with superficial inferior epigastric. The tram transverse rectus abdominis myocutaneous technique has been improved. Raising of microvascular flaps a systematic approach. Rectus abdominis function, action, origin and insertion. Breast reconstruction with autologous tissue transfer is now a standard operation, but abnormalities of the abdominal wall contour represent a complication which has led surgeons to invent techniques to minimize the morbidity of the donor site. Recovery after transverse rectus abdominis myocutaneous. Modified vertical rectus abdominis myocutaneous flap. Your surgeon has decided to use tissue from the rectus muscle in your abdomen to rebuild your surgery site at your oral cavity mouth area.
Rectus abdominis free flap iowa head and neck protocols. The rectus abdominis myocutaneous ram free flap is a versatile tool for the reconstructivesurgeon. Transverse rectus abdominis myocutaneous flaps versus deep inferior epigastric perforator flaps. You will be redirected to the full text document in the repository in a few seconds, if not click here.
Your surgical team will connect blood vessels from the free flap to blood vessels in your head or neck. The operation identifies and dissects blood vessels that perforate the rectus abdominis muscle as they travel to supply blood to the abdominal wall. We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap tramflap breast reconstruction. Bipedicled tram flap with rectus abdominis muscle preservation.
Free rectus abdominis myocutaneous flap for lower extremity reconstruction. Pdf laparoscopic transverse rectus abdominus flap delay. However, despite its advantages, the free siea flap for breast reconstruction is rarely used. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. The modified vertical rectus abdominis myocutaneous flap vram is a safe option for vaginal reconstruction at the time of pelvic exenteration. Posteriorly angles with the pelvis region, flexion of the vertebral segment, packs stomach substance, helps with strength termination. During a pedicle flap mammoplasty reconstruction, a commonly used muscle is the. The origin of the muscles is the pubic symphysis and pubic crest, while the insertion is the fifth to seventh costal cartilages. Significant morbidity can result from perineal wounds, particularly after radiotherapy and extensive resection for cancer. Versatility of vertical rectus abdominis musculocutaneous. Five of the flaps were inferiorly based and two superiorly based.
Rectus abdominis muscle flap, after being harvested, was tied to nasogastric tube brought out of duodenal fistula that was then pulled back in the stomach. Flap related complications after vram reconstruction were uncommon even in a high risk population. Pectoralis majorrectus abdominis bipedicled muscle flap in the. The donor site was closed primarily unless a large skin paddle was taken, in which case the donor site was skin grafted. Reconstruction with rectus abdominis myocutaneous free flap. Your hospital stay after rectus abdominis free flap surgery.
Learn about the rectus abdominis muscle flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. The muscle is enclosed by the rectus sheath, but below the arcuate line, this sheath disappears posterior to the muscle. From the inferomedial costal edge and back part of the xiphoid procedure of the sternum and fifth to seventh costal ligaments. Pdf maxillary reconstruction using free rectus abdominis. Breast reconstruction with a transverse rectus abdominis myocutaneous flap. The superiorly based partial rectus abdominis and external oblique flap. A prospective study was conducted of the reliability and outcomes of the use of siea flaps for breast reconstruction compared with transverse rectus abdominis muscu. B, view of a large congenital left diaphragmatic defect.
Our patient was treated with this technique without any complication. Get a printable copy pdf file of the complete article 1. A new technique for breast asymmetry reconstruction. Additional features in this edition include highly useful modifications of elevation of the radial forearm flap as well as new chapters on the rectus abdominis flap, a reliable option for covering deep and extended defects, and the medial sural perforator flap.
The bipedicled tram flap technique with preservation of the rectus abdominis muscles below the arcuate line and without the. The rectus abdominis free flap in head and neck reconstruction. The authors present modified vertical rectus abdominis musculocutaneous vram flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Anterolateral abdominal wall consists of 3 muscle layers. In the same year, robbins6 described this as a pedunculated flap. The muscle flap will be divided along the rectus abdominis dotted line. Bilateral anterior rectus sheath turnover flap for. Abdominal based free flaps such as the transverse rectus abdominis myocutaneous tram flap and deep inferior epigastric perforator. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. It is a com posite flap and comprises muscle, over. Introduction it is important for reconstructive surgeons to evaluate swallowing function in patients with tongue cancer who have undergone glossectomy and flap reconstruction. Breast reconstruction with a transverse rectus abdominis. Although the transverse rectus abdominis musculocutaneous tram flap is the gold standard in. Rectus abdominis myocutaneous flaps for perineal reconstruction.
Chapter the rectus abdominis muscle flap thieme connect. C, after division of the avascular plan between the ta and the io muscles, the. The rectus abdominis flap is based on the deep inferior epigastric artery. Laparoscopic transverse rectus abdominus flap delay for autogenous breast reconstruction. Rather than taking the entire muscle or a small portion of the muscle, the small blood vessels an artery and a vein that come through the muscle to the skin. Pdf primary rectus abdominis myocutaneous flap for. Modified vertical rectus abdominis musculocutaneous flap. To assess pain and activity limitations and to determine realistic goals for recovery.
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