Groin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Obliteration of empyema tract with deepithelialized. 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. 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. The development of ever more sophisticated methods of postmastectomy breast reconstruction culminated in the early 1980s with the transverse rectus abdominis musculocutaneous tram flap. Rotation of the skin island into the long axis of the rectus muscle has added considerable length to this flap, allowing it. The deepithelialized skin island has provided sufficient bulk for tract obliteration. This dissection is carried laterally to 1 cm medial of the linea semilunaris. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. The tram flap is still among the most used free flaps for extensive soft. The rectus abdominis muscle advancement flap as a salvage option. Radial forearm and rectus abdominis free flap reconstruction ravi pachigolla, md anna pou, md history of microvascular free flap reconstruction.
Reconstructive surgery for head and neck cancer patients. This article reports free rectus abdominis musculocutaneous flap transplantation for patients with chronic ppes. Contour abnormalities of the abdomen after transverse. Modifications to the standard surgical technique may reduce complications and improve the versatility of this flap. 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. It is a composite flap and comprises muscle, overlying fascia and skin. Subtotal glossectomy, rectus abdominis musculocutaneous flap, swallowing function, hyoid bone movement, width of the esophageal entrance 1. Free musculocutaneous flap transplantation may provide a good alternative option in the treatment of these refractory complications after pulmonary resections.
It is a com posite flap and comprises muscle, over lying fascia and skin. The oblique rectus abdominis musculocutaneous flap. It extends from the rib cage all the way to the pubic bone. 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. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and. 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. Experience with 60 inferior rectus abdominis flaps journal of. 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. Vertical rectus abdominis musculocutaneous flap an. Free rectus abdominis musculocutaneous flap for chronic. Bottero l, lefaucheur jp, fadhul s, raulo y, collins ed, lantieri l. The paired rectus muscles provide abdominal flexion and support for the intraabdominal contents.
Three patients with chronic postoperative empyemas combined with bronchopleural fistulas underwent obliteration of the empyema tracts with free rectus abdominis. Four patients with chronic empyema after pneumonectomy have undergone successful obliteration of the empyema tract with a deepithelialized transverse rectus abdominis myocutaneous flap. The rectus abdominis myocutaneous flap to be described was successfully used in one such case. The authors present their experience with a previously described but infrequently used variation of the rectus abdominis myocutaneous flap. There are two parallel muscles, separated by a midline band of connective tissue called the linea alba. Rectus abdominis muscle flap for repair of prepubic tendon. The arrangement of the layers has important variations at different locations in the body. Gluteal fold flap for pelvic and perineal reconstruction. Rectus abdominis, informally known as the abs muscle, is a long muscle of the anterior abdominal wall.
Breast reconstruction by the free lower transverse rectus. The muscle is enclosed within the rectus sheath formed by the aponeuroses of the lateral abdominal muscles. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap rff, has been performed by plastic and reconstructive surgeons. Outcome of rectus femoris muscle flaps performed by. C, after division of the avascular plan between the ta and the io muscles, the. Following successful management of her colon, small bowel and stomach injuries, the acute abdominal wall recon struction was accomplished with prolene mesh. It presents a good alternative for reconstruction of this difficult problem. Pulmonary function after pedicled transverse rectus. The muscle is enclosed by the rectus sheath, but below the arcuate line, this sheath disappears posterior to the muscle. View and download powerpoint presentations on free flaps ppt. A rectus abdominis myocutaneous flap to reconstruct.
At this insertion the aponeurosis is fused with the aponeurosis of the transversus abdominis muscle to form the conjoint tendon. 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. 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. 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. During a pedicle flap mammoplasty reconstruction, a commonly used muscle is the.
Chronic postoperative empyema remains a challenge for thoracic surgeons. The first version of the vertical rectus abdominis vram flap for breast reconstruction was reported by drever4 in 1977. Learn about the rectus abdominis muscle flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. Rectus abdominis flap technique for head and neck reconstruction. Pdf a new technique of closing a gastroatmospheric. Vertical rectus abdominis musculocutaneous flap an overview. Rectus abdominis article about rectus abdominis by the. Below the arcuate line the aponeurosis passes anterior to the rectus muscle.
The abdominal wall and hernias university of tennessee. This has the great virtue of being a large mass of soft, autogenous tissue which does not require supplementary silicone prosthesis augmentation. The anterolateral thigh flap for groin and lower abdominal defects. The rectus sheath, also called the rectus fascia, is formed by the aponeuroses of the transverse abdominal and the internal and external oblique muscles. Rectus abdominis musculocutaneous flap can provide a large bulk of tissue for obliteration of a huge residual space.
Distant flaps vi gastrocnemius muscle flap vii transverse rectus abdominis muscle flap tram flap. The rectus abdominis free flap is one of the most versatile softtissue flaps. Postmastectomy breast reconstruction have been the object of a series of studies by plastic surgeons and mastologists. B, view of a large congenital left diaphragmatic defect. Swallowing function before and after subtotal glossectomy. A prospective study of donorsite morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. 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. The purpose of this article was to quantitate pulmonary function in patients who underwent pedicled tram flap breast. Since then i have been able to gather practical experience by applying. Inferior pedicle is based on inferior epigastric vessels. Breast reconstruction with transverse rectus abdominis.
In contrast to creating large skin flaps to access and divide the eo muscle, tar begins by entering the posterior rectus sheath. The inferior part of the aponeurosis inserts into the symphysis pubis. Electromyographic assessment of rectus abdominis muscle function after deep. The rectus abdominis flap is favored for this application because of.
Case report a middleaged woman suffered a closerange shotgun blast. Vaginal reconstruction washingtonian plastic surgery. Additionally, the rectus abdominis contains several transverse tendinous intersections which may provide additional strength. Here, we describe the use of bilateral gluteal fold flaps for pelvic and perineal reconstruction following. 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 rectus abdominis free flap, harvested as a myocutaneous flap or as a musclesparing variant i. Risk factors and surgical refinements of postresective mandibular reconstruction. T1 pulmonary function after pedicled transverse rectus abdominis musculocutaneous flap breast reconstruction. 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. Radial forearm and rectus abdominis free flap reconstruction ravi pachigolla, md anna pou, md history of microvascular free flap reconstruction radial forearm. We describe a previously unreported technique of advancing the rectus abdominis muscle superiorly, based on the deep inferior epigastric.
The lower abdominal skin flap is designed with the suprapubic skin crease, in line with. 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. Along the length of this strap muscle there are three fibrous. When performing a rhinoplasty, the hump in the nose is removed. 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. Rectus abdominis musculocutaneous flap incision academy. Reconstruction of complex groin defects with inferior epigastric arterybased rectus abdominis muscle flaps fig. The most common flap harvested from the abdominal wall is the vertical rectus abdominis myocutaneous vram flap. While the pain onin your belly occurs on the side of the rectus abdominis that is affected, the back. The number of reports on its applications in the head and neck is limited.
It contains the rectus abdominis and pyramidalis muscles it can be divided into anterior and posterior laminae. The flap may be advantageous for cases in which a large tongue. Superior pedicle is based on superior epigastric vessels. Complications in breast reconstruction using a transverse. 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. Transverse rectus abdominis musculocutaneous flap tram. Rectus abdominis belongs to the anterior abdominal muscles together with pyramidalis muscle.
The rectus abdominis flap is based on the deep inferior epigastric artery. Anterolateral abdominal wall consists of 3 muscle layers. Radial forearm and rectus abdominis free flap reconstruction ppt presentation summary. 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. What anatomy is relevant to a superior and inferior. 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. Introduction it is important for reconstructive surgeons to evaluate swallowing function in patients with tongue cancer who have undergone glossectomy and flap reconstruction. Transversus abdominis release for ventral hernia repair. The muscle flap will be divided along the rectus abdominis dotted line.
Successful techniques include longterm antibiotic therapy, operative debridement, and muscle flap coverage. Rectus abdominis free flap iowa head and neck protocols. Reconstruction of complex groin defects with inferior. The lower abdominal skin is used in the tram, just as in the diep and siea flap. 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. This study evaluated the effect of postoperative irradiation on transverse rectus abdominis muscle tram flap breast reconstruction. The rectus sheath is formed from decussating fibres from all three lateral abdominal muscles. Transversus abdominis release tar is the most recent technique to address limitations of traditional reconstructive options. The rectus abdominis myocutaneous flap has been used as the first choice for pelvic and perineal reconstruction. Learn about the rectus abdominis musculocutaneous flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. Figure 1 the operative technique of the pedicled transverse rectus abdominis myocutaneous 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. An important area of weakness that should be recognized when securing abdominal closure after flap harvest. Primary selection of a pedicled rectus femoris flap for. 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. Rectus sheath the rectus sheath is a long fibrous sheath that encloses the rectus abdominis muscle and pyramidalis muscle if present. 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. Find powerpoint presentations and slides using the power of, find free presentations research about free flaps ppt. B the upper abdominal flap is elevated above the fascia to the level of the costal margin.
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