Pdf laparoscopic transverse rectus abdominus flap delay. The rectus abdominis flap is favored for this application because of its ease of harvest and reliability. 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 tram transverse rectus abdominis myocutaneous technique has been improved. 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. Your surgical team will connect blood vessels from the free flap to blood vessels in your head or neck. 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 oblique rectus abdominis musculocutaneous flap. Flap related complications after vram reconstruction were uncommon even in a high risk population. Pdf rectus abdominis myofascial flap for vaginal reconstruction.
The rectus abdominis myocutaneous ram free flap is a versatile tool for the reconstructivesurgeon. This document was downloaded for personal use only. Page 2 of 5 your hospital stay after rectus abdominis free flap surgery. You will be redirected to the full text document in the repository in a few seconds, if not click here.
The origin of the muscles is the pubic symphysis and pubic crest, while the insertion is the fifth to seventh costal cartilages. Modifications to the standard surgical technique may reduce complications and improve the versatility of this flap. 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. The rectus abdominus myoperitoneal flap for vaginal.
Recovery after transverse rectus abdominis myocutaneous. Transplantation of a transverse rectus abdominis myocutaneous tram flap is a commonly used surgical procedure for breast reconstruction following mastectomy. A comparison of perioperative blood transfusions and other. Myocutaneous flaps have been used to improve healing. 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. Free rectus abdominis myocutaneous flap for lower extremity reconstruction.
The operation identifies and dissects blood vessels that perforate the rectus abdominis muscle as they travel to supply blood to the abdominal wall. You will begin to increase your activity every day. Rectus abdominis musculocutaneous flap incision academy. Repair of duodenal fistula with rectus abdominis muscle.
Microvascular surgery protocols general considerations. 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. Several techniques for vaginal reconstruction after pelvic exenteration such as myocutaneous and myoperitoneal flaps are. It is a composite flap and comprises muscle, overlying fascia and skin. Abdominal based free flaps such as the transverse rectus abdominis myocutaneous tram flap and deep inferior epigastric perforator. 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. 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. 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. To assess pain and activity limitations and to determine realistic goals for recovery. In this publication, he also proposed using this flap for many reconstructive purposes, especially in the head and neck region, as a.
B, view of a large congenital left diaphragmatic defect. Which of the following is the most likely duration of the global period for this patient. Pdf maxillary reconstruction using free rectus abdominis. Maxillary reconstruction using free rectus abdominis myocutaneous flap combined with vascularized costal cartilages. It has been used extensively as both a pedicled and free flap for breast reconstruction.
Case report treatment of sternal osteomyelitis after open. Introduction it is important for reconstructive surgeons to evaluate swallowing function in patients with tongue cancer who have undergone glossectomy and flap reconstruction. The muscle flap will be divided along the rectus abdominis dotted line. 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. Tendinous intersections incriptiones tendinae further subdivide each rectus abdominis muscle into a. Muscle was then anchored to the edges of duodenal fistula with few interrupted 20 vicryl sutures. When performing a rhinoplasty, the hump in the nose is removed. Breast reconstruction with superficial inferior epigastric. Experience with 60 inferior rectus abdominis flaps journal of. Uwmc otolaryngology head and neck surgery center box 356161 1959 n.
Objectiveto present a 1stage technique for orbital reconstruction after exenteration with the use of myocutaneous rectus abdominis free flap in children. We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap tramflap breast reconstruction. The bipedicled tram flap technique with preservation of the rectus abdominis muscles below the arcuate line and without the. Bipedicled tram flap with rectus abdominis muscle preservation.
Although the transverse rectus abdominis musculocutaneous tram flap is the gold standard in. The diep flap utilizes the same lower abdominal skin and fat as the tram and free tram flap. 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. View and download powerpoint presentations on free flaps ppt. The rectus abdominis muscle itself lies within the rectus sheath, which is formed by the merging of the aponeurosis of transversus abdominis, external and internal oblique abdominal muscles. The first version of the vertical rectus abdominis vram flap for breast reconstruction was reported by drever4 in 1977.
Versatility of vertical rectus abdominis musculocutaneous. The paired rectus muscles provide abdominal flexion and support for the intraabdominal contents. Reconstruction of abdominal wall defects using extended. The transverse rectus abdominis myocutaneous freeflap, created from the transverse abdominal muscle, is a breast reconstruction flap harvested. Seven large defects of the lower torso were closed with rectus abdominis musculocutaneous flaps. The rectus abdominis flap is based on the deep inferior epigastric artery. Rectus abdominis flap technique for head and neck reconstruction. Breast cancer is the leading cause of death in the female population. It is a com posite flap and comprises muscle, over. She says she is worried that she might not be able to afford additional followup visits should she be obligated to pay. Reconstruction with rectus abdominis myocutaneous free flap. Does the use of an acellular dermal graft in abdominal.
Complications in breast reconstruction using a transverse. The use of an inferiorly based rectus abdominis myocutaneous flap taken. Rectus abdominis function, action, origin and insertion. Reconstruction of complex groin defects with inferior epigastric arterybased rectus abdominis muscle flaps fig. 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.
During a pedicle flap mammoplasty reconstruction, a commonly used muscle is the. Discuss the surgical techniques used in breast reconstruction with both pedicled and free tram. The muscle can be up to 30 cm long and up to 10 centimeters wide. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. 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. From the inferomedial costal edge and back part of the xiphoid procedure of the sternum and fifth to seventh costal ligaments. The rectus abdominis free flap is one of the most versatile softtissue flaps. Free rectus abdominis myocutaneous flap for lower extremity. The rectus abdominis muscle flap provides a local option for defects anywhere in the anterior abdominal wall. 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. 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.
Learn about the rectus abdominis musculocutaneous flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. Reconstruction of complex groin defects with inferior. The superiorly based partial rectus abdominis and external oblique flap. The donor site was closed primarily unless a large skin paddle was taken, in which case the donor site was skin grafted. 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. The authors present modified vertical rectus abdominis musculocutaneous vram flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Raising of microvascular flaps a systematic approach. Find powerpoint presentations and slides using the power of, find free presentations research about free flaps ppt. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and. It can be harvested as a muscleonly flap or as a myocutaneous flap. Pdf primary rectus abdominis myocutaneous flap for. The superiorly based partial rectus abdominis and external o. In the same year, robbins6 described this as a pedunculated flap. Modified vertical rectus abdominis myocutaneous flap.
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. However, despite its advantages, the free siea flap for breast reconstruction is rarely used. Anterolateral abdominal wall consists of 3 muscle layers. The purpose of the study was to demonstrate a variety of indications for the vertical rectus abdominis musculocutaneous vram flap with respect to donorsite morbidity and alternative procedures. When compare the anterior rectus sheath turnover flap with dual mesh, it is obvious that anterior rectus sheath turnover flap is more cost effective. Five of the flaps were inferiorly based and two superiorly based. C, after division of the avascular plan between the ta and the io muscles, the. 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. 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. The transversus abdominis is the deepest of the three muscles and its fibers run in a horizontal direction. Get a printable copy pdf file of the complete article 1. 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. Breast reconstruction with a transverse rectus abdominis myocutaneous flap. Significant morbidity can result from perineal wounds, particularly after radiotherapy and extensive resection for cancer.
Microvascular flap course attendence is limited to max. Pectoralis majorrectus abdominis bipedicled muscle flap in the. The purpose of this study was to evaluate the morbidity and results of. The modified vertical rectus abdominis myocutaneous flap vram is a safe option for vaginal reconstruction at the time of pelvic exenteration. Swallowing function before and after subtotal glossectomy. External oblique is the most superficial muscle of the anterior abdominal wall. Breast reconstruction with a transverse rectus abdominis. The number of reports on its applications in the head and neck is limited. An important area of weakness that should be recognized when securing abdominal closure after flap harvest. 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.
Modified vertical rectus abdominis musculocutaneous flap. Your hospital stay after rectus abdominis free flap surgery. Subtotal glossectomy, rectus abdominis musculocutaneous flap, swallowing function, hyoid bone movement, width of the esophageal entrance 1. Rbcp complications in breast reconstruction using a. 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 very important to have a good blood supply to the free flap tissue so. The muscle is enclosed by the rectus sheath, but below the arcuate line, this sheath disappears posterior to the muscle. To reduce this trauma, reconstructive surgery offers different options including the use of a retail transverse rectus abdominis tram flap. Posteriorly angles with the pelvis region, flexion of the vertebral segment, packs stomach substance, helps with strength termination. A new technique for breast asymmetry reconstruction.
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. Our patient was treated with this technique without any complication. Transverse rectus abdominis myocutaneous flaps versus deep inferior epigastric perforator flaps. Rectus abdominis free flap after uneventful resection of tumor, internal jugular vein and. The treatment for breast cancer is primarily surgical, which has a great psychosocial impact on women.
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