Uwmc otolaryngology head and neck surgery center box 356161 1959 n. The paired rectus muscles provide abdominal flexion and support for the intraabdominal contents. Firstly, the peritoneum is closed by free fascia lata transplantation. Impact on breast cancer recurrence after mastectomy. Get a printable copy pdf file of the complete article. The rectus abdominis muscle can be used to supplement a pectoralis major muscle flap when additional bulk is needed or when the pectoralis major muscle is not available. Vertical rectus abdominis musculocutaneous flap an. Initial experience with breast reconstruction using the. The rectus abdominis musculoperitoneal flap consisted of the rectus muscle, posterior rectus sheath, peritoneum, the 10th, 11th and 12th intercostal nerves, and the deep inferior epigastric artery and veins. The most common flap harvested from the abdominal wall is the vertical rectus abdominis myocutaneous vram flap.
The rectus abdominis flap is favored for this application because of its ease of harvest and reliability. In a tram flap, the surgeon first removes muscle, fat and skin from the lower abdomen. The rectus abdominis muscle flap has been described for this purpose, usually rotating the flap external to the pelvis or inguinal ligament. The modified vertical rectus abdominis myocutaneous flap vram is a safe option for vaginal reconstruction at the time of pelvic exenteration. Free rectus abdominis musculocutaneous flap for chronic. Swallowing function before and after subtotal glossectomy and. The purpose of this study was to evaluate the morbidity and results of. A case series of roboticassisted rectus abdominis 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. Objective to evaluate the clinical use and outcome of a rectus abdominis microvascular free flap for wound closure in dogs. Pdf primary rectus abdominis myocutaneous flap for. Flap related complications after vram reconstruction were uncommon even in a high risk population. We describe a previously unreported technique of advancing the rectus abdominis muscle superiorly, based on the deep inferior epigastric. Rectus abdominis flap technique for head and neck reconstruction. Your hospital stay after rectus abdominis free flap surgery. Five patients underwent immediate reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy. Groin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Rectus abdominis belongs to the anterior abdominal muscles together with pyramidalis muscle. 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.
In 1979, holmstrom5 was the first to employ the free rectus abdominis musculocutaneous flap for breast reconstruction. The objective of this study was to analyze the early and late flap related morbidity and associated risk factors in the largest series of patients with modified vertical rectus abdominis myocutaneous vram flap vaginal reconstruction at the time of pelvic exenteration for gynecologic malignancy. How would a transverse rectus abdominis musculocutaneous flap be classified. This case report describes the treatment of a chronically infected hip prosthesis using a pedicled rectus flap passed directly through.
Reexploration of vertical rectus abdominis myocutaneous flap for. Between a dominant lateral row perforator and a dominant medial with long intramuscular course perforator, we favor the latter, because it is more centrally located and is. Microvascular surgery protocols general considerations. It extends from the pubic symphysis, pubic crest and pubic tubercle inferiorly, to the. Versatility of vertical rectus abdominis musculocutaneous. Pdf facial reconstruction of a mucormycosis survivor by. The technique of distally placing vertical rectus abdominis myocutaneous flaps has previously been described in detail. The rectus abdominis free flap is one of the most versatile softtissue flaps. Rectus abdominis is the muscle that runs vertically adjacent to the umbilicus along the whole abdomen from the sternum up to the pubic bone. Complications in breast reconstruction using a transverse. In those with low body fat, it is clearly visible beneath the skin forming the six pack. Pdf the versatility of the pedicled vertical rectus abdominis. The rectus abdominis flap has been used extensively as both a pedicled and free flap for chest reconstruction because the technique is simple, it is quick to harvest and is generally reliable. This has been confirmed by ct scan of the abdominal wall in.
Significant morbidity can result from perineal wounds, particularly after radiotherapy and extensive resection for cancer. In the same year, robbins6 described this as a pe dunculated flap. Reconstruction of a soft tissue defect as well as revascularization of an ischemic organ the tongue was simultaneously achieved with a single flap transfer. Nov 07, 2014 the rectus abdominis muscle is located in the front of the body, beginning at the pubic bone and ending at the sternum. Extended rectus abdominis free flap, longest myocutaneous. The muscle flap will be divided along the rectus abdominis dotted line. During a pedicle flap mammoplasty reconstruction, a commonly used muscle is the. 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. Outcome analysis of breast reconstruction with free. The dissection of the rectus abdominis myocutaneous flap with. 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. To the best of our knowledge, this is the first report of a free inferior rectus abdominis musculocutaneous flap used successfully as a bridge flap. The rectus abdominis muscle flap is a workhouse flap that can be used in pelvic reconstruction, providing a large volume of soft tissue coverage for interposition and tissue defects following fistula repair, abdominoperineal resection apr and pelvic exenteration.
The rectus abdominis myocutaneous flap smith 1998 cancer. Transverse rectus abdominis musculocutaneous flap radiology. Furthermore, immediate reconstruction has the advantage of a single procedure with less psychological morbidity, and reduction in hospital stay and overall complication rate. We have modified the rectus abdominis myocutaneous free flap in seven patients for reconstruction of the skull base.
The free transverse rectus abdominis musculocutaneous flap for breast reconstruction. This article documents the history of the tram flap and puts in context the. In other words, in almost 50 percent of cases, a deep inferior epigastric artery perforator flap could be based on a perforator with no impact on rectus muscle innervation. This same branch travels to supply the tissue of the anterolateral thigh flap.
When harvesting a rectus flap, the anterior rectus sheath is incised vertically over the midportion of the rectus muscle, whereas the posterior sheath is preserved. Fifteen vram flaps were performed in 15 patients during a 4. One option for breast reconstruction is a transverse rectus abdominus myocutaneous tram flap procedure. Rectus abdominis free muscle flap for reconstruction in. Lam department of plastic and reconstructive surgery, westmead hospital, sydney, australia abstract objective. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap rff, has been performed by plastic and reconstructive surgeons. Breast reconstruction with a deep inferior epigastric. The pedicled transverse rectus abdominis myocutaneous tram flap remains a viable option in breast reconstruction. Reconstruction of complex groin defects with inferior epigastric arterybased rectus abdominis muscle flaps fig. Page 2 of 5 your hospital stay after rectus abdominis free flap surgery. A rectus abdominis myocutaneous flap to reconstruct abdominal. 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. Outcome of rectus femoris muscle flaps performed by. Avoiding denervation of rectus abdominis in diep flap.
It is recommended that the rectus muscle below the entry of the inferior epigastric artery is not completely divided to prevent kinking of the vessels. The impact of cta in preoperative planning of deep. Before the flap procedure, the integrity of the internal thoracic artery to the rectus abdominis muscle was confirmed using duplex echocardiographic scanning. Reconstruction with rectus abdominis myocutaneous free. Callegari the technique of surgical delay has been employed for many decades as a reliable method to increase the viable dimensions of a flap. The average age of patients was 58 years range, 3476 years. The rectus abdominis myocutaneous flap to be described was successfully used in one such case. Although tram flap reconstruction is frequently considered the most efficient technique for breast.
The superiorly based partial rectus abdominis and external. The purpose of the study was to demonstrate a variety of indications for the vertical rectus abdominis musculocutaneous vram flap with respect to donor. The rectus abdominis muscle has a type iii mathes and nahai vascular supply, meaning dominant perfusion from both the superior and the deep inferior epigastric vessels. An inferior rectus abdominis bridge flap for revascularizati. When the rectus abdominis free flap is used for very large facial defects, some deformities may remain 6 despite the flap. The rectus abdominis muscle advancement flap as a salvage option. Pdf using of pedicled rectus abdominis musculocutaneous. C, after division of the avascular plan between the ta and the io muscles, the. A rectus myocutaneous flap procedure was successfully undertaken on pod 8, but the patient died on pod 14. An important area of weakness that should be recognized when securing abdominal closure after flap harvest. The first version of the vertical rectus abdominis vram flap for breast reconstruction was reported by drever4 in 1977. Lateral parts of the muscle are consequently denervated during a transverse rectus abdominis musculocutaneous flap, which preserves them. We have an experience of very thin rectus abdominis muscle during the tram flap. Reconstruction with rectus abdominis myocutaneous free flap.
Following successful management of her colon, small bowel and stomach injuries, the acute abdominal wall recon struction was accomplished with prolene mesh. We performed peritoneal reconstruction by free fascia lata transplantation and abdominal wall reconstruction with an extended trilobed rectus abdominis musculocutaneous flap. The pedicled tram flap in breast reconstruction request pdf. Recovery after transverse rectus abdominis myocutaneous flap. Sep 23, 2016 transverse rectus abdominis myocutaneous flaps with preoperative delay paul r. Figure 2 transverse rectus abdominis myocutaneous flap variants used for breast reconstructions, between august 2007 and august 2012, at the university hospital walter cantidio. It is a composite flap and comprises muscle, overlying fascia and skin. The rectus abdominis muscle, also known as the abdominal muscle, is a paired muscle running vertically on each side of the anterior wall of the human abdomen, as well as that of some other mammals. Based superiorly on the deep superior epigastric artery, a terminal branch of the ima, this type iii muscle can be turned on itself to fill a defect of the chest wall or. Invasive sinonasal mucormycosis is a rare fungal infection that usually occurs in immunocompromised or diabetic patients, and it is often fatal.
Simultaneous bilateral breast reconstruction with the transverse rectus abdominus musculocutaneous free flap. To assess pain and activity limitations and to determine realistic goals for recovery. Rectus abdominis function, action, origin and insertion. This is an important psychological consideration in growing children as well as in adults. The defect was covered with a rectus abdominis freetissue flap and a splitthickness skin graft 20. Rectus abdominis muscle an overview sciencedirect topics.
The rectus abdominis muscle is elevated, pedicled on the deep superior epi. Case report a middleaged woman suffered a closerange shotgun blast. This flap provides vascularized autologous volume to the. May 12, 2020 rectus abdominis, informally known as the abs muscle, is a long muscle of the anterior abdominal wall. 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. The rectus abdominis free flap after orbital exenteration produces very good aesthetic results immediately after the 1stage procedure. Another early report of flap raising procedures at the anterior abdominal wall including parts of the rectus muscle was given by brown et al. All or some of this muscle and a flap of local skin and fat is moved to the chest to form a reconstructed breast. The subcutaneous fat was sculptured to form a soft, vascularized cork and was used for obliteration of the irregular deep portions of defects at the midcranial base against the repaired or unrepaired dura. This technique was used in 20 consecutive patients.
The number of reports on its applications in the head and neck is limited. The flap may be pedicled on the superior epigastric system, as first described by hartrampf et al. Modified vertical rectus abdominis myocutaneous flap. The authors present a case of a woman patient suffering from systemic lupus erythematosus and diabetes.
Abdominal closure after tram flap breast reconstruction. Rectus abdominis musculocutaneous flap incision academy. Tram flap the rectus abdominis muscle is a muscle in the lower abdomen that runs from the breastbone to the pubic bone. Introduction it is important for reconstructive surgeons to evaluate swallowing function in patients with tongue cancer who have undergone glossectomy and flap reconstruction. Risk factors and blood flow in the free transverse rectus abdominis tram flap smoking and high flap weight impair the free tram flap microcirculation darren i. Following transverse rectus abdominis myocutaneous flaps versus deep inferior epigastric perforator flaps rajith a. The transverse rectus abdominis myocutaneous flap has been proven to give good results in terms of restoration of body symmetry with near normal contour and consistency.
Breast reconstruction with a transverse rectus abdominis. This article reports free rectus abdominis musculocutaneous flap transplantation for patients with chronic ppes. In the setting of breast reconstruction, pedicled transverse rectus abdominis muscle tram flap is known to be associated with abdominal bulging and ventral hernias in up to 63% and 18% of patients, respectively. The blood supply to the rectus femoris is via the lateral femoral circumflex artery descending branch. Since then i have been able to gather practical experience by applying. Transverse rectus abdominis myocutaneous flaps with. It is often used as a pedicled flap in reconstruction of the anterior abdominal wall. Anterolateral abdominal wall consists of 3 muscle layers. Learn about the rectus abdominis musculocutaneous flap, an online 3dvideobased course, accredited by the royal college of surgeons of england.
Reconstruction of the tongue with reinnervated rectus. Reconstruction of complex groin defects with inferior. Rbcp complications in breast reconstruction using a. It extends from the rib cage all the way to the pubic bone. Denervation is an important complication as it aborts the main advantage of the diep flap technique. Free rectus abdominis myocutaneous flap with anterior rectus sheath to provide the orbital support in globesparing total maxillectomy.
The origin of the muscles is the pubic symphysis and pubic crest, while the insertion is the fifth to seventh costal cartilages. There are two parallel muscles, separated by a midline band of connective tissue called the linea alba. In the same year, robbins6 described this as a pedunculated flap. Subtotal glossectomy, rectus abdominis musculocutaneous flap, swallowing function, hyoid bone movement, width of the esophageal entrance 1. Swallowing function before and after subtotal glossectomy. A comparison of perioperative blood transfusions and other.
B, view of a large congenital left diaphragmatic defect. Rectus abdominis muscle flap is widely using method for reconstruction for large defect. This flap is the slightly modified and free version of a similar flap described by ian. Transosseous transposition of a pedicled rectus abdominis. Flap reconstruction breast reconstruction cancer council nsw. Recovery after transverse rectus abdominis myocutaneous.
The use of an inferiorly based rectus abdominis myocutaneous flap taken through the pelvis is described. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Mar 03, 2016 the rectus abdominis flap is favored for this application because of its ease of harvest and reliability. 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. This is called a transverse rectus abdominis myocutaneous tram flap. The extended deep inferior epigastric flap, described by taylor et al. The external oblique muscle flap can be harvested in several ways to capture overlying fat and skin. Successful techniques include longterm antibiotic therapy, operative debridement, and muscle flap coverage. Transverse rectus abdominis myocutaneous flaps for breast reconstruction are associated with significantly higher flap necrosis rates for smokers than nonsmokers 19% vs 9%, p0. In that procedure, the abdominal skin, subcutaneous fat, and rectus abdominis muscle with its associated native vasculature are used to create a neobreast.
During the past 4 years, 3 patients who presented with chronic ppes with bpfs 2 on the right side, 1 on the left side after pulmonary resections underwent free rectus abdominis musculocutaneous flap transposition as follows. Full text full text is available as a scanned copy of the original print version. Nine patients underwent free tram flap transfers for breast reconstruction 10 flaps, and 11 patients. The flap may be advantageous for cases in which a large tongue. Reconstruction of abdominal wall defects using extended. Abdominal region is a unique donor area in the reconstructive surgery to provide numerous flaps. Simultaneous bilateral breast reconstruction with the. Transverse rectus abdominis musculocutaneous flap an. When the pedicled tram flap is considered for reconstruction, an extremely thin muscle pedicle can cause circulation problems. Rectus abdominis myofascial flap for vaginal reconstruction after pelvic exenteration article pdf available in annals of plastic surgery 815. In this study, we describe the use of a superiorly based partial rectus and external oblique flap for surgical correction of lower pole breast hypoplasia. Abdominal based free flaps such as the transverse rectus ab. Therefore, our aim was to evaluate preoperative and postoperative swallowing function in a patient after such reconstruction. The muscle is generally more developed in gym goers and athletes in whom the muscle.
Pdf the vertical rectus abdominis muscle vram flap is considered a safe and simple option to cover defects of the trunk and proximal thigh. Experience with 60 inferior rectus abdominis flaps journal of. If you lack sufficient abdominal tissue, areas such as the back, buttocks or thigh may be used instead. Modified vertical rectus abdominis myocutaneous flap vaginal. They are commonly known as abdominals or abs muscles and are present in the pair at the front wall of the abdomen. Reconstruction of extensive abdominal wall defects is difficult in many cases. Rectus abdominis myocutaneous flap after unsuccessful. It has been used extensively as both a pedicled and free flap for breast reconstruction. Table 1 distribution of patients with and without postoperative complications according to the transverse rectus abdominis myocutaneous tram flap variant used. Myocutaneous flaps have been used to improve healing. The vertical rectus abdominis myocutaneous vram flap is a versatile and well established reconstructive technique for many defects created as a result of. Discuss the surgical techniques used in breast reconstruction with both pedicled and free tram.
The rectus abdominis free flap in head and neck reconstruction. Animals dogs n9 with complex extremity or oral wounds. Detailed analysis of the vascular anatomy of the abdominal wall has extended the uses of the transverse rectus abdominis musculocutaneous flap from pr. The muscle can be up to 30 cm long and up to 10 centimeters wide. Rectus abdominis musclemusculocutaneous flap in chestwall. In this study, swallowing function was evaluated with video fluorography in a patient with tongue cancer before and after subtotal glossectomy and reconstruction with a rectus abdominis musculocutaneous flap. Risk factors and blood flow in the free transverse rectus. Tendinous intersections incriptiones tendinae further subdivide each rectus abdominis muscle into a series of smaller false muscle bellies. When performing a rhinoplasty, the hump in the nose is removed. Immediate breast reconstruction using free transverse rectus abdominis myocutaneous flap.
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