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

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.

2021 ◽  
Vol 4 (1) ◽  
pp. 84-85
Author(s):  
David George Pennington

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


2017 ◽  
Vol 02 (02) ◽  
pp. e126-e131 ◽  
Author(s):  
Seiko Okumura ◽  
Meisei Takeishi ◽  
Ryota Nakamura ◽  
Satoshi Kakutani ◽  
Ikuo Hyodo ◽  
...  

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.


2004 ◽  
Vol 53 (3) ◽  
pp. 199-204 ◽  
Author(s):  
Laszlo Kovacs ◽  
Nikolaos A. Papadopulos ◽  
Samir A. Ammar ◽  
Markus Kl??ppel ◽  
Peter Herschbach ◽  
...  

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