scholarly journals Effectiveness of “Indocyanine Green Dye Clamp Test” in Selecting Perforators for Muscle-Sparing-2 Transverse Rectus Abdominis Myocutaneous Flaps in Breast Reconstruction

2017 ◽  
Vol 02 (02) ◽  
pp. e126-e131 ◽  
Author(s):  
Seiko Okumura ◽  
Meisei Takeishi ◽  
Ryota Nakamura ◽  
Satoshi Kakutani ◽  
Ikuo Hyodo ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Indocyanine Green ◽  
Contralateral Side ◽  
Rectus Abdominis ◽  
Tram Flap ◽  
Vascular Pedicle ◽  
Transverse Rectus Abdominis Myocutaneous ◽  
Indocyanine Green Dye ◽  
Muscle Sparing ◽  
Selection Of

Introduction In breast reconstruction for cases in which tissue from zones 1 to 4 is required or a lower midline scar exists, it is possible to predict the need for vascular anastomosis with a vascular pedicle on the contralateral side if the dominant territory of each perforator can be identified in advance. In addition, it is possible to determine whether a single- or multiple-perforator-based flap is needed. We, therefore, developed the “indocyanine green dye (ICG) clamp test” to select perforators for breast reconstruction. Methods The blood flow of a perforator was blocked using a microvascular clamp when determining its inclusion in a flap. The clamps were released after the enlargement of the ICG fluorescence imaging range. The enlarged imaging range was then observed to determine whether an additional pedicle was required. Subjects One hundred thirty-two breast reconstruction procedures had been performed using the free muscle-sparing-2 transverse rectus abdominis myocutaneous (MS2 TRAM) flap method from May 2012 to December 2015. The population of the present study included 29 of these cases in which the selection of perforators was deemed necessary. Results We investigated the cases in which anastomosis of the contralateral vascular pedicle was unnecessary. It was possible to preserve the medial muscle in 79.3% of the cases using our procedure. Conclusion Our newly developed ICG clamp test was useful in selecting perforators for MS2 TRAM flaps and facilitated the performance of minimally invasive surgery.

scholarly journals Muscle-sparing pedicled transverse rectus abdominis myocutaneous flaps for breast reconstruction: Combining benefits of both worlds

2018 ◽  
Vol 28 (1) ◽  
pp. 6-9
Author(s):  
Yijun Wu ◽  
Samuel Yew Ming Ho
Keyword(s):  
Breast Reconstruction ◽  
Hospital Stay ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Rectus Abdominis ◽  
Control Group ◽  
Tram Flap ◽  
Transverse Rectus Abdominis Myocutaneous ◽  
Pain Scores ◽  
Muscle Sparing

Background: Breast reconstruction plays a vital role in the restoration of form post-mastectomy. Autologous breast reconstructions using both free as well as pedicled flaps form the bulk of the breast reconstruction in our centre. Objective: This study seeks to evaluate the muscle-sparing modification of the pedicled transverse rectus abdominis myocutaneous (MS-TRAM) flaps against conventional transverse rectus abdominis myocutaneous (TRAM) flaps, in an attempt to marry the benefits of both and minimise the drawbacks of each technique. Patients and methods: A retrospective analysis of 20 women, 10 of whom had undergone unilateral immediate breast reconstruction with pedicled MS-TRAM flaps after skin-sparing mastectomy (MS group), and 10 who had undergone the conventional pedicled TRAM flap (control group) by the same surgeon (S. Ho) over a two-year period from 2013 to 2015 was performed. Patients’ records were reviewed, assessing patient demographics including age, smoking status and evaluating the operative time, time to ambulation, length of hospital stay, pain scores and abdominal bulge rates. Results: Mean operative time was not significantly longer in the MS group. Pain scores were lower in the MS group. The length of hospital stay was not significantly different between the two groups. Abdominal bulge rates at 24 months postoperatively were 0% in the MS group patients and 10% in the control group. Conclusion The pedicled MS-TRAM flap is an excellent breast reconstruction option that is comparable to the conventional TRAM flap. It preserves innervated muscle in the donor site that reduces time to ambulation and postoperative pain. It does not add significantly to surgical time and does not require microvascular anastomosis.

scholarly journals Application of Botulinum Neurotoxin Injections in TRAM Flap for Breast Reconstruction: Intramuscular Neural Arborization of the Rectus Abdominis Muscle

Toxins ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 269
Author(s):  
Kyu-Ho Yi ◽  
Hyung-Jin Lee ◽  
Ji-Hyun Lee ◽  
Kyle K. Seo ◽  
Hee-Jin Kim
Keyword(s):  
Breast Reconstruction ◽  
Botulinum Neurotoxin ◽  
Rectus Abdominis ◽  
Tram Flap ◽  
Rectus Abdominis Muscle ◽  
Cross Sectional ◽  
Transverse Rectus Abdominis Myocutaneous ◽  
Intramuscular Nerves ◽  
The Ideal

Breast reconstruction after mastectomy is commonly performed using transverse rectus abdominis myocutaneous (TRAM) flap. Previous studies have demonstrated that botulinum neurotoxin injections in TRAM flap surgeries lower the risk of necrosis and allow further expansion of arterial cross-sectional diameters. The study was designed to determine the ideal injection points for botulinum neurotoxin injection by exploring the arborization patterns of the intramuscular nerves of the rectus abdominis muscle. A modified Sihler’s method was performed on 16 rectus abdominis muscle specimens. Arborization of the intramuscular nerves was determined based on the most prominent point of the xyphoid process to the pubic crest. All 16 rectus abdominis muscle specimens were divided into four muscle bellies by the tendinous portion. The arborized portions of the muscles were located on the 5–15%, 25–35%, 45–55%, and 70–80% sections of the 1st, 2nd, 3rd, and 4th muscle bellies, respectively. The tendinous portion was located at the 15–20%, 35–40%, 55–60%, and 90–100% sections. These results suggest that botulinum neurotoxin injections into the rectus abdominis muscles should be performed in specific sections.

Free and Muscle-Sparing Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction

2020 ◽  
pp. 155-162
Author(s):  
Leo Lara Espinoza ◽  
Ricardo Cavalcanti Ribeiro ◽  
Rafael Garrido Costa ◽  
Luis Fernandez de Cordova ◽  
Flavio Marques de Carvalho
Keyword(s):  
Breast Reconstruction ◽  
Myocutaneous Flap ◽  
Rectus Abdominis ◽  
Transverse Rectus Abdominis Myocutaneous ◽  
Rectus Abdominis Myocutaneous Flap ◽  
Muscle Sparing

Ischemic Complications in Pedicle, Free, and Muscle Sparing Transverse Rectus Abdominis Myocutaneous Flaps for Breast Reconstruction

2008 ◽  
Vol 60 (5) ◽  
pp. 562-567 ◽  
Author(s):  
Patricio Andrades ◽  
R Jobe Fix ◽  
Stefan Danilla ◽  
Robert E. Howell ◽  
William J. Campbell ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Rectus Abdominis ◽  
Transverse Rectus Abdominis Myocutaneous ◽  
Myocutaneous Flaps ◽  
Ischemic Complications ◽  
Muscle Sparing

scholarly journals Response to ‘Australia's contribution to the free abdominoplasty flap in breast reconstruction’

2021 ◽  
Vol 4 (1) ◽  
pp. 84-85
Author(s):  
David George Pennington
Keyword(s):  
Breast Reconstruction ◽  
Rectus Abdominis ◽  
The Other ◽  
Tram Flap ◽  
Transverse Rectus Abdominis Myocutaneous ◽  
Surgical Teams

Perhaps few realise that the development of what became known as the free transverse rectus abdominis myocutaneous (TRAM) flap was a race involving not one but two surgical teams, one in Sydney and the other, with the aid of the Australian Richard Hamilton, in Sweden

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