Breast reconstruction with transverse rectus abdominis. Contour abnormalities of the abdomen after transverse. This article reports free rectus abdominis musculocutaneous flap transplantation for patients with chronic ppes. Reconstruction of complex groin defects with inferior. Complications in breast reconstruction using a transverse. Transversus abdominis release for ventral hernia repair.
Modifications to the standard surgical technique may reduce complications and improve the versatility of this flap. Vertical rectus abdominis musculocutaneous flap an. Learn about the rectus abdominis muscle flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. Introduction it is important for reconstructive surgeons to evaluate swallowing function in patients with tongue cancer who have undergone glossectomy and flap reconstruction. View and download powerpoint presentations on free flaps ppt. Successful techniques include longterm antibiotic therapy, operative debridement, and muscle flap coverage. Inferior pedicle is based on inferior epigastric vessels. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and. Vaginal reconstruction washingtonian plastic surgery. The development of ever more sophisticated methods of postmastectomy breast reconstruction culminated in the early 1980s with the transverse rectus abdominis musculocutaneous tram flap.
The rectus femoris pedicled muscle flap is a widely used option for coverage of infected vascular grafts in groin reconstruction as well as in reconstruction of abdominal wall defects. However, due to previous abdominal surgery and multiple stoma placements in our patients, the rectus abdominis myocutaneous flap could not be used for such reconstruction. The oblique rectus abdominis musculocutaneous flap. Learn about the rectus abdominis musculocutaneous flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. Free rectus abdominis musculocutaneous flap for chronic. Transversus abdominis release tar is the most recent technique to address limitations of traditional reconstructive options. The lower abdominal skin is used in the tram, just as in the diep and siea flap. It contains the rectus abdominis and pyramidalis muscles it can be divided into anterior and posterior laminae. Case report a middleaged woman suffered a closerange shotgun blast.
After the flap is removed, the abdominal skin and fat is undermined above the rectus sheath to the costal margin green arrows and line to allow closure of the donor defect. It extends from the rib cage all the way to the pubic bone. Four patients with chronic empyema after pneumonectomy have undergone successful obliteration of the empyema tract with a deepithelialized transverse rectus abdominis myocutaneous flap. As you can see in the two pictures, the rectus abdominis can send pain to the lower region of your belly as well as to your lower and mid back the deeper the red, the more common it is to experience pain if this muscle is too tight or afflicted with trigger points note. What anatomy is relevant to a superior and inferior. When performing a rhinoplasty, the hump in the nose is removed. Since then i have been able to gather practical experience by applying. Radial forearm and rectus abdominis free flap reconstruction ravi pachigolla, md anna pou, md history of microvascular free flap reconstruction radial forearm. In contrast to creating large skin flaps to access and divide the eo muscle, tar begins by entering the posterior rectus sheath.
We describe a previously unreported technique of advancing the rectus abdominis muscle superiorly, based on the deep inferior epigastric. Rectus abdominis, informally known as the abs muscle, is a long muscle of the anterior abdominal wall. Undoubtedly, the most common design when using the rectus abdominis flap is the tram transverse rectus abdominis muscle flap with a horizontal orientation, using the deep inferior epigastric vessels as the pedicle and incorporating the skin from the entire lower abdomen, but many other variations of the skin paddle have been described, such. T1 pulmonary function after pedicled transverse rectus abdominis musculocutaneous flap breast reconstruction. The tram flap is still among the most used free flaps for extensive soft. 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. Rectus abdominis belongs to the anterior abdominal muscles together with pyramidalis muscle. The flap may be advantageous for cases in which a large tongue. This study evaluated the effect of postoperative irradiation on transverse rectus abdominis muscle tram flap breast reconstruction. It extends from the rib cage all the way to the pubic bone rectus abdominis belongs to the anterior abdominal muscles together with pyramidalis muscle. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap rff, has been performed by plastic and reconstructive surgeons. The deepithelialized skin island has provided sufficient bulk for tract obliteration. The rectus abdominis muscle, also known as the abdominal muscle or abs, 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. Outcome of rectus femoris muscle flaps performed by.
This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Postmastectomy breast reconstruction have been the object of a series of studies by plastic surgeons and mastologists. The first version of the vertical rectus abdominis vram flap for breast reconstruction was reported by drever4 in 1977. Vertical rectus abdominis musculocutaneous flap an overview.
The rectus abdominis myocutaneous flap to be described was successfully used in one such case. The anterolateral thigh flap for groin and lower abdominal defects. Superior pedicle is based on superior epigastric vessels. A prospective study of donorsite morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Three patients with chronic postoperative empyemas combined with bronchopleural fistulas underwent obliteration of the empyema tracts with free rectus abdominis. Breast reconstruction with transverse rectus abdominis myocutaneous flap tram, single pedicle, including closure of donor site cpt code information is available to subscribers and includes the cpt code number, short description, long description, guidelines and more. The rectus abdominis myocutaneous flap has been used as the first choice for pelvic and perineal reconstruction. The number of reports on its applications in the head and neck is limited. The inferior part of the aponeurosis inserts into the symphysis pubis. The muscle is enclosed by the rectus sheath, but below the arcuate line, this sheath disappears posterior to the muscle. Technique 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. Skin paddles angled obliquely from the line of the rectus abdominis and toward the rib cage were successfully carried on periumbilical perforators from the inferior epigastric system. The authors present their experience with a previously described but infrequently used variation of the rectus abdominis myocutaneous flap. The rectus abdominis muscle flap retains the transversalis fascia dorsally, which provides additional strength that the cranial sartorius muscle, which has no fascial covering, lacks.
The rectus abdominis and rectus sheath the rectus muscle extends from the xiphoid process of the sternum and 5,6,7th costal cartilages to the pubic symphysis and pubic crest. Electromyographic assessment of rectus abdominis muscle function after deep. Risk factors and surgical refinements of postresective mandibular reconstruction. Obliteration of empyema tract with deepithelialized. It is a com posite flap and comprises muscle, over lying fascia and skin. Figure 1 the operative technique of the pedicled transverse rectus abdominis myocutaneous tram flap. Rectus abdominis muscle pullin flap for closure of duodenal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients.
While the pain onin your belly occurs on the side of the rectus abdominis that is affected, the back. Rectus abdominis article about rectus abdominis by the. This has the great virtue of being a large mass of soft, autogenous tissue which does not require supplementary silicone prosthesis augmentation. Transverse rectus abdominis musculocutaneous flap tram. Breast reconstruction by the free lower transverse rectus. The muscle can be up to 30 cm long and up to 10 centimeters wide.
Pdf a new technique of closing a gastroatmospheric. 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. Reconstruction of complex groin defects with inferior epigastric arterybased rectus abdominis muscle flaps fig. The rectus abdominis muscle advancement flap as a salvage option. The rectus abdominis free flap, harvested as a myocutaneous flap or as a musclesparing variant i.
In those with low body fat, it is clearly visible beneath the skin forming the six pack. Along the length of this strap muscle there are three fibrous. 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. Bottero l, lefaucheur jp, fadhul s, raulo y, collins ed, lantieri l. The muscle is enclosed within the rectus sheath formed by the aponeuroses of the lateral abdominal muscles. Following successful management of her colon, small bowel and stomach injuries, the acute abdominal wall recon struction was accomplished with prolene mesh. Primary selection of a pedicled rectus femoris flap for. B, view of a large congenital left diaphragmatic defect. Rectus abdominis musculocutaneous flap can provide a large bulk of tissue for obliteration of a huge residual space. Below the arcuate line the aponeurosis passes anterior to the rectus muscle. Distant flaps vi gastrocnemius muscle flap vii transverse rectus abdominis muscle flap tram flap. Anterolateral abdominal wall consists of 3 muscle layers. Additionally, the rectus abdominis contains several transverse tendinous intersections which may provide additional strength. The muscle flap will be divided along the rectus abdominis dotted line.
Radial forearm and rectus abdominis free flap reconstruction ppt presentation summary. Subtotal glossectomy, rectus abdominis musculocutaneous flap, swallowing function, hyoid bone movement, width of the esophageal entrance 1. C, after division of the avascular plan between the ta and the io muscles, the. A rectus abdominis myocutaneous flap to reconstruct. Reconstructive surgery for head and neck cancer patients. Despite on training guides focusing on working on different regions upper middle lower of the anterior abs, the rectus abdominis is just one big muscle so no matter where one thinks they are focusing they are still working on a single muscle a more muscular lower back is correlated with a better rectus abdominis because many of the exercises required for the abs focus on back strength as well.
Rectus abdominis flap technique for head and neck reconstruction. Chronic postoperative empyema remains a challenge for thoracic surgeons. Tight abdominal closures, as can be seen during transverse rectus abdominis musculocutaneous tram flap breast reconstruction, have been shown to increase intraabdominal pressure, thereby decreasing thoracopulmonary compliance and increasing the workload of breathing. Here we present the case of primary placement of a pedicled rectus femoris flap to provide wellvascularized tissue interposed between an aortic dacron interposition graft and bowel. Rectus abdominis musculocutaneous flap incision academy. It is a composite flap and comprises muscle, overlying fascia and skin. Here, we describe the use of bilateral gluteal fold flaps for pelvic and perineal reconstruction following. The rectus abdominis flap is favored for this application because of. The rectus sheath is formed from decussating fibres from all three lateral abdominal muscles. The rectus sheath, also called the rectus fascia, is formed by the aponeuroses of the transverse abdominal and the internal and external oblique muscles.
The paired rectus muscles provide abdominal flexion and support for the intraabdominal contents. It presents a good alternative for reconstruction of this difficult problem. Swallowing function before and after subtotal glossectomy. Experience with 60 inferior rectus abdominis flaps journal of. At this insertion the aponeurosis is fused with the aponeurosis of the transversus abdominis muscle to form the conjoint tendon. Among the several technichs proposed, the transverse rectus abdominis musculocutaneous flap tram flap have been the preferred choice in many services that work in the area of reconstructive surgery. B the upper abdominal flap is elevated above the fascia to the level of the costal margin.
Contour abnormalities of the abdomen after transverse rectus abdominis muscle tram flap breast reconstruction occur with all methods of flap elevation and include lower and upper abdominal. The rectus abdominis free flap is one of the most versatile softtissue flaps. Outline radial forearm flaps lateral arm flaps lateral thigh flap anterolateral thigh flap rectus abdominis flaps latissimus dorsi flap gracilis flap temperoparietal fascial flap fibular osteocutanous flap iliac crest flaps scapular flaps metatarsal flap rib flaps jejunum omentum gastroomentum. The arrangement of the layers has important variations at different locations in the body. Groin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Free musculocutaneous flap transplantation may provide a good alternative option in the treatment of these refractory complications after pulmonary resections.
Find powerpoint presentations and slides using the power of, find free presentations research about free flaps ppt. There are two parallel muscles, separated by a midline band of connective tissue called the linea alba. The most common flap harvested from the abdominal wall is the vertical rectus abdominis myocutaneous vram flap. The lower abdominal skin flap is designed with the suprapubic skin crease, in line with. The abdominal wall and hernias university of tennessee.
The vertical rectus abdominis musculocutaneous vram flap was the earliest. The purpose of this article was to quantitate pulmonary function in patients who underwent pedicled tram flap breast. The rectus abdominis flap is based on the deep inferior epigastric artery. During a pedicle flap mammoplasty reconstruction, a commonly used muscle is the. Radial forearm and rectus abdominis free flap reconstruction ravi pachigolla, md anna pou, md history of microvascular free flap reconstruction. Gluteal fold flap for pelvic and perineal reconstruction. Rotation of the skin island into the long axis of the rectus muscle has added considerable length to this flap, allowing it.
Rectus abdominis muscle flap for repair of prepubic tendon. It extends from the pubic symphysis, pubic crest and pubic tubercle inferiorly, to. Rectus abdominis free flap iowa head and neck protocols. Rectus sheath the rectus sheath is a long fibrous sheath that encloses the rectus abdominis muscle and pyramidalis muscle if present. Pulmonary function after pedicled transverse rectus. A preoperative planning photographs showing the area of flap design and the ipsilateral muscle pedicle site. An important area of weakness that should be recognized when securing abdominal closure after flap harvest. This dissection is carried laterally to 1 cm medial of the linea semilunaris.
1205 776 1469 791 518 90 1180 643 1191 1410 1100 323 1366 498 1185 128 895 487 453 1269 388 787 1386 1306 244 360 1381 42 366 482 1424 13 1012 41 126 728 617 68 539 127 269 22 403