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Pedicle tram flap

Antonio Espinosa-de-Los-Monteros, Héctor Avendano-Peza, Yuri W Novitsky
Breast reconstruction with a pedicled transverse rectus abdominis muscle (TRAM) flap can result in significant abdominal wall donor-site morbidity. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. We present our novel technique of posterior components separation with transversus abdominis muscle release and retromuscular mesh reinforcement for donor-area closure during pedicled TRAM flap breast reconstruction...
September 2016: Plastic and Reconstructive Surgery. Global Open
Samuel Golpanian, David J Gerth, Jun Tashiro, Seth R Thaller
INTRODUCTION: Conventionally, free transverse rectus abdominis myocutaneous (fTRAM) flap breast reconstruction has been associated with decreased donor site morbidity and improved flap inset. However, clinical success depends upon more sophisticated technical expertise and facilities. This study aims to characterize postoperative outcomes undergoing free versus pedicled TRAM (pTRAM) flap breast reconstruction. METHODS: Nationwide inpatient sample database (2008-2011) was reviewed for cases of fTRAM (ICD-9-CM 85...
October 14, 2016: Aesthetic Plastic Surgery
Ki Yong Hong, Lan Sook Chang, Hak Chang, Kyung Won Minn, Ung Sik Jin
BACKGROUND: Breast reconstruction with microvascular free tissue transfer has become a widely used method. Despite a high rate of success, a compromised flap necessitating re-exploration can occur. Here, we introduce direct thrombectomy as a flap salvage technique, and compared the results with conventional thrombectomy. METHODS: A total of 488 patients who underwent breast reconstruction using a free transverse rectus abdominis myocutaneous flap between March 2009 and February 2014 were retrospectively analyzed...
October 5, 2016: Microsurgery
Jeong Tae Kim, Youn Hwan Kim, Sang Wha Kim
INTRODUCTION: Fibrin sealants have had applications in hemostasis, cohesion, and promotion of healing in plastic surgery. In this article, we review cases where fibrin sealant was used to stabilize microvascular pedicles and compared with previous free flaps performed without fibrin sealant. METHODS: Between 2008 and 2010, 62 consecutive patients underwent free tissue transfer for reconstruction; this involved 33 latissimus dorsi perforator flaps, 14 thoracodorsal artery perforator flaps, 9 latissimus dorsi myocutaneous flaps, 3 lateral thoracic artery perforator flaps, and 3 transverse rectus abdominis myocutaneous flaps, used in head and neck reconstruction, lower limb reconstructions, breast reconstructions, and facial palsy reconstruction...
September 16, 2016: Microsurgery
Prakasit Chirappapha, Ongart Somintara, Panuwat Lertsithichai, Youwanush Kongdan, Chairat Supsamutchai, Rupporn Sukpanich
BACKGROUND: There are several techniques for harvesting the pedicled transverse rectus abdominis myocutaneous (TRAM) flap after mastectomy in breast cancer patients. We examined the whole muscle with partial sheath sparing technique and determined factors associated with its complications and oncological outcomes. METHODS: We retrospectively reviewed the results of 168 TRAM flaps performed between January 2003 and December 2010, focusing on complications and oncologic outcomes...
August 2016: Gland Surgery
Chin-Ta Lin, Tim-Mo Chen
Chylous ascites is a rare clinical condition that occurs as a consequence of disruption of the abdominal lymphatics. Here, we present the case of a 58-year-old woman with sustained chylous ascites after pedicled transverse rectus abdominis myocutaneous (TRAM) flap harvest. The chylous ascites did not decrease despite conservative therapy. For the diagnosis and localization of the chyle leakage, lymphangiography with lipiodol delivery was performed. Chylous drainage continued in a decreasing manner for the next 4 d because lipiodol accumulated to the point of leakage outside the lymphatic vessel causing a regional inflammatory reaction and obstructing the lymphatic vessels...
August 18, 2016: Acta Chirurgica Belgica
Jun-Dong Wu, Wen-He Huang, Si-Qi Qiu, Li-Fang He, Cui-Ping Guo, Yong-Qu Zhang, Fan Zhang, Guo-Jun Zhang
Breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) flap is challenging in patients with low midline abdominal scar. In this study, we aimed to investigate the clinical feasibility of immediate breast reconstruction using single-pedicle TRAM (SP-TRAM) flaps in patients with low midline abdominal scar. There were 4 strict selection criteria: 1) presence at least 3 perforators on the pedicle side; 2) perforators with regional average flow velocity of >20 cm/s; 3) upper edge of the abdominal scar at least 4 cm from the umbilicus; and 4) scar age >1 year...
2016: Scientific Reports
Taik Jong Lee, Tae Suk Oh, Eun Key Kim, Hyunsuk Suh, Sei Hyun Ahn, Byung Ho Son, Jong Won Lee, Jonghan Cho, Jin Sup Eom
BACKGROUND: The purpose of this study was to determine the risk factors associated with mastectomy skin flap necrosis during immediate reconstruction with TRAM or DIEP flaps. METHODS: This study reviewed 1116 cases of immediate breast reconstruction over 10 years. Patients ranged in age from 29-76 years (average = 45.1 years), and had an average follow-up period of 65.6 months. Thirteen factors (age, BMI (body mass index), smoking habits, diabetes ptosis grade, midclavicle-to-nipple distance, neoadjuvant chemotherapy, free or pedicled flap, mastectomy method, surgeon, stage, axillary dissection, mastectomy weight) known to be associated with mastectomy flap necrosis were retrospectively analysed...
October 2016: Journal of Plastic Surgery and Hand Surgery
Edward I Chang, Steven J Kronowitz
BACKGROUND: In thin patients or when a significant amount of skin is needed, use of the entire abdomen to reconstruct a single breast may be necessary. In this article, the authors present their 15-year experience in dual-pedicle flap evolution and optimization of flap design. METHODS: A retrospective review was conducted of all bipedicle flaps performed from 2000 to 2015. RESULTS: Overall, 57 patients (mean age, 49.2 years; mean body mass index, 26...
May 2016: Plastic and Reconstructive Surgery
Ashraf Khater
Creating TRAM flap in obese patient is a challenging issue with a hazard of flap ischemia and breast envelope loss or sepsis. In this case we show our experience in doing an interval TRAM flap in markedly obese patient (BMI index 39) in the presence of Desmoid tumor of the anterior abdominal wall on top of previous mesh hernioplasty in the contralateral side of the tumor. Interval TRAM was decided with achieving of a complete vascular delay in the same sitting with skin sparing mastectomy. On doing abdominal ultrasonography for perforator mapping a desmoid tumor was encountered in the contralateral side...
December 2015: Indian Journal of Surgical Oncology
Murat Gorkem Ataman, Cagri A Uysal, Nilgun Markal Ertas, Nilufer Bayraktar, Aysen Terzi, Huseyin Borman
BACKGROUND: Transverse rectus abdominis musculocutaneous (TRAM) flap is one of the options in reconstruction after breast cancer surgery for breast reconstruction. Tissue necrosis often occurs in the third and fourth perfusion zones of the flap. A study was planned to find out the effects of adipose stromal vascular fraction (SVF) cells on viability of TRAM flap and the experimental model was designed to be applicable in clinical practice. METHODS: Right inferior epigastric artery pedicled, 5 × 2...
October 2016: Journal of Plastic Surgery and Hand Surgery
Tae Hwan Park, Ji Hae Park, Choong Hyun Chang, Dong Kyun Rah
UNLABELLED: Angiogenesis is the development of new capillaries from existing blood vessels and is a prerequisite for the wound-healing process. Many lines of scientific evidences have shown that complicated roles of small guanosine triphosphatases (GTPases) (ras-related C3 botulinum toxin substrate 1 [Rac1], cell division control protein 42 [Cdc42], and ras homolog gene family, member A [RhoA]) in regulation of signal transduction pathways exist to transmit distinct cellular effects on the modulation of actin cytoskeleton remodeling such as cell cycle progression, cell survival, and cell motility...
March 2016: Journal of Craniofacial Surgery
Hung-Wen Lai, Shou-Tung Chen, Dar-Ren Chen, Shu-Ling Chen, Tsai-Wang Chang, Shou-Jen Kuo, Yao-Lung Kuo, Chin-Sheng Hung
BACKGROUND: Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan. METHODS: The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database...
2016: PloS One
Sheina A Macadam, Toni Zhong, Katie Weichman, Michael Papsdorf, Peter A Lennox, Alexes Hazen, Evan Matros, Joseph Disa, Babak Mehrara, Andrea L Pusic
BACKGROUND: Approximately 20 percent of women select autologous tissue for postmastectomy breast reconstruction, and most commonly choose the abdomen as the donor site. An increasing proportion of women are seeking muscle-sparing procedures, but the benefit remains controversial. It is therefore important to determine whether better outcomes are associated with these techniques, thereby justifying longer operative times and increased costs. METHODS: Patients from five North American centers were eligible if they underwent reconstruction by means of the deep inferior epigastric artery perforator (DIEP) flap, muscle-sparing free transverse abdominis myocutaneous (TRAM) flap, free TRAM flap, or the pedicled TRAM flap...
March 2016: Plastic and Reconstructive Surgery
Valeriy Shubinets, Justin P Fox, Jonathan R Sarik, Stephen J Kovach, John P Fischer
BACKGROUND: Donor-site hernia is one of the most feared complications following abdominally based autologous breast reconstruction. The authors aim to assess the incidence of surgically repaired abdominal hernia across different types of abdominally based breast reconstruction, identify predictive perioperative factors, and estimate the health care charges associated with this morbidity. METHODS: Using inpatient and ambulatory surgery data from four states in the United States, the authors identified adult women who underwent pedicled transverse rectus abdominis muscle (TRAM), free TRAM, or deep inferior epigastric perforator (DIEP) flap breast reconstruction between 2008 and 2012...
March 2016: Plastic and Reconstructive Surgery
Chi Sun Yoon, Kyu Nam Kim
The introduction of microsurgery has decreased the frequency of using the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, owing to its higher incidence of fat necrosis and limitations in flap insetting (vs. the free TRAM flap). We devised an efficient method of using zones 2 and 4, based on the pedicled flap's vascular anatomy, to reduce fat necrosis and achieve superior aesthetic outcomes during immediate breast reconstruction using the pedicled TRAM flap. Between April 2011 and February 2015, we performed immediate breast reconstruction using the contralateral unipedicled TRAM flap for 136 breast cancer patients...
2016: SpringerPlus
Kai Yang, Lan Mu, Yan Liu, Zhe Peng, Guangxue Li
OBJECTIVE: To investigate the utility of indocyanine green angiography in flap reconstructive surgery and possibility of decrease the complications. METHODS: Indocyanine green angiography was performed on 14 patients undergoing flap reconstructive surgery between February and December 2014 to evaluate the blood perfusion of the flap and to adjust the operation plan. Of 14 cases, 2 were male and 12 were female, aged 23-58 years (mean, 35.5 years); 11 flaps were used for breast reconstruction [including 3 free deep inferior epigastric antery perforator (DIEP) flaps, 4 pedicled transverse rectus abdominis myocutaneous flaps (TRAM), 2 pedicled TRAM and free TRAM, and 2 pedicled latissimus dorsi myocutaneous flaps and prosthesis], 1 pedicled latissimus dorsi myocutaneous flap for repairing chest wall defect, 1 pedicled profunda artery perforator (PAP) flap for upper leg defect, and 1 pedicled descending genicular artery perforator flap for knee defect...
September 2015: Chinese Journal of Reparative and Reconstructive Surgery
Sadaf Alipour, Ramesh Omranipour, Rahim Akrami
Transverse rectus abdominis musculocutaneous (TRAM) flap is the most common procedure performed for breast reconstruction after mastectomy for breast cancer. Obesity is a relative contraindication, and complex modifications have been proposed in the pedicled technique for obese patients. We studied ischemic complications in our patients to investigate the effect of body weight on the outcome of TRAM flap breast reconstruction. Pertinent data from medical records of patients receiving a TRAM flap surgery from 1986 to 2011 were extracted...
December 2015: Indian Journal of Surgery
Sophocles H Voineskos, Simon G Frank, Peter G Cordeiro
Breast reconstruction can be performed using a variety of techniques, most commonly categorized into an alloplastic approach or an autologous tissue method. Both strategies have certain risk factors that influence reconstructive outcomes and complication rates. In alloplastic breast reconstruction, surgical outcomes and complication rates are negatively impacted by radiation, smoking, increased body mass index (BMI), hypertension, and prior breast conserving therapy. Surgical factors such as the type of implant material, undergoing immediate breast reconstruction, and the use of fat grafting can improve patient satisfaction and aesthetic outcomes...
December 2015: Gland Surgery
Benlong Yang, Lin Li, Wenhui Yan, Jiaying Chen, Ying Chen, Zhen Hu, Guangyu Liu, Zhenzhou Shen, Zhimin Shao, Jiong Wu
BACKGROUND: The goal of this study was to evaluate patient satisfaction with four common types of breast reconstruction performed at our institution: latissimus dorsi myocutaneous (LDM) flap reconstruction with or without implants, pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction, and free deep inferior epigastric perforator (DIEP) flap reconstruction. METHODS: A custom survey consisting of questions that assessed general and aesthetic satisfaction was sent to patients who had undergone breast reconstruction in the last 5 years...
2015: PloS One
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