Abdominal wall repair with double-mesh polypropylene/polyglecaprone after TRAM flap surgery for breast reconstruction

ABSTRACT Background: The pedicled TRAM flap has been a workhorse of autologous breast reconstruction for decades. However, there has been a rising concern about the abdominal wall donor site morbidity with the use of conventional TRAM flap. This has generally been cited as one of the main reasons for resorting to “abdominal wall friendly” techniques. This study has been undertaken to assess the abdominal wall function in patients with pedicled TRAM flap breast reconstruction. The entire width of the muscle and the overlying wide disk of anterior rectus sheath were harvested with the TRAM flap in all our patients and the anterior rectus sheath defect was repaired by a Proline mesh. Materials and Methods: Abdominal wall function was studied in 21 patients who underwent simultaneous primary unipedicled TRAM flap reconstruction after mastectomy for cancer. In all the patients, the abdominal wall defect was repaired using wide sheet of Proline mesh both as inlay and onlay. The assessment tools included straight and rotational curl ups and a subjective questionnaire. The abdominal wall was also examined for any asymmetry, bulge, or hernia. The minimal follow-up was 6 months postoperative. The objective results were compared with normal unoperated volunteers. Results and Conclusions: The harvesting the TRAM flap certainly results in changes to the anterior abdominal wall that can express themselves to a variable degree. A relatively high incidence of asymptomatic asymmetry of the abdomen was seen. There was total absence of hernia in our series even after a mean follow-up period of 15.5 months. A few patients were only able to partially initiate the sit up movement and suffered an important loss of strength. In most patients, synergists took over the functional movement but as the load increased, flexion and rotation performances decreased. The lack of correlation between exercise tests and the results of the questionnaire suggests that this statistically significant impairment was functionally not important. The patients encountered little or no difficulty in theis day-to-day activities. Our modification of use of a wide mesh as inlay and onlay repair minimizes the donor site morbidity. This also avoids maneuvers meant for primary closure of the rectus sheath defects, which can result in distortion of umbilicus. Therefore, in conclusion, the unipedicled TRAM flap should be regarded as a valuable option in breast reconstruction provided careful repair of the abdominal wall defect is undertaken using Proline mesh.

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Influence of Vascular Delay on Abdominal Wall Complications in Unipedicled TRAM Flap Breast Reconstruction

Annals of Plastic Surgery ◽

10.1097/01.sap.0000037342.23064.c4 ◽

2003 ◽

Vol 50 (2) ◽

pp. 138-142 ◽

Cited By ~ 10

Author(s):

Rory F. Rickard ◽

Don A. Hudson

Keyword(s):

Breast Reconstruction ◽

Abdominal Wall ◽

Tram Flap ◽

Vascular Delay

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Comparison of Strategies for Preventing Abdominal-Wall Weakness after TRAM Flap Breast Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199206000-00007 ◽

1992 ◽

Vol 89 (6) ◽

pp. 1045-1051 ◽

Cited By ~ 116

Author(s):

Stephen S. Kroll ◽

Marcello Marchi

Keyword(s):

Breast Reconstruction ◽

Abdominal Wall ◽

Tram Flap

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Flap Surgical Techniques For Incisional Hernias Reccurences. A Swine Experimental Model

Medicine and Pharmacy Reports ◽

10.15386/cjmed-684 ◽

2017 ◽

Vol 90 (2) ◽

pp. 203-211

Author(s):

Florina Popa ◽

Filip Ardelean ◽

Cosmin Pestean ◽

Robert Purdoiu ◽

Oana Rosca ◽

...

Keyword(s):

Abdominal Wall ◽

Mesh Repair ◽

Surgical Techniques ◽

Careful Examination ◽

Large Animal ◽

Abdominal Wall Defects ◽

Flap Surgery ◽

Abdominal Wall Repair ◽

Large Animal Models ◽

The University

Background and aims. In the age of synthetic prostheses most of hernia studies include a careful examination of the various types of prosthesis, their characteristics and their repair indications. Biological prostheses are also beginning to draw attention. But in terms of recurrence especially for poor or developing countries, the discussion is different, due to their high cost which makes them difficult to afford. In this article we present new flap reconstruction techniques for the reconstruction of the abdominal wall versus mesh repair, applied on swine models, outline the results of each technique, and specify the indications for their use.Methods. An experimental protocol using four swine models (PIC-FII-337 hybrid breed pigs), five months old, was conducted. All animal care and operative procedures were studied following the protocol approved by the Ethics Committee of the University of Medicine and Pharmacy resolution no. 281/2014 of the Department of Surgery of the University of Agricultural Sciences and Veterinary Medicine); the study was carried out between November 2015 and February 2016. The primary objective was to compare the effect of surgical strategies in the treatment of the abdominal wall defect using variable flaps versus mesh repair in a large-animal models. Physical examination and ultrasound imaging of the abdominal wall repair were done on determined periods, during one month. The complications occurring after the abdominal wall repair were edema, collections, superficial dehiscence an recurrences.Results. No recurrences were reported at one month results, all seromas reported were solved over time by natural drainage. Superficial necrosis appeared in two swine models and superficial dehiscence occurred in one model, the perforator ”plus” flap. Mesh infection was detected in the “onlay” swine model.Conclusions. In terms of recurrences, contaminated abdominal wall defects or other contraindications to the use of prosthetic materials, biological mesh repair or flap surgery are the only surgical options. Based on our findings and considering the high cost reported by the biological meshes use, flap surgery becomes the suitable treatment for such cases, allowing a good reconstruction of the abdominal wall.

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