A comparison study of deep muscle sparing transverse rectus abdominis musculocutaneous flap for breast reconstruction

Abstract

Background: Breast reconstruction by deep inferior epigastric perforator flap (DIEP) involves only little rectus abdominis muscle sacrifice. However, the operative procedure may get complicated. We propose here a novel method involving two adjacent perforators and requiring the addition of only the superficial muscle to the flap. This novel technique, termed "deep muscle sparing transverse rectus abdominis musculocutaneous flap (DMS-TRAM)," was compared to DIEP and MS-TRAM groups.Methods: The subjects were 70 patients. The indication of DMS-TRAM was the distance between two perforators penetrating the deep fascia was <3 cm, and the two perforators ran through the superficial layer of the muscle until they became confluent. All patients were evaluated by contrasting computed tomography. The data of age, body mass index, flap volume, operative time, blood loss, laterality, immediate reconstruction, prior radiation, smoking, re-exploration, total flap necrosis, partial fat necrosis, and abdominal bulging were compared. Ultimately, DMS-TRAM was applied in 20 subjects (28.6%), DIEP in 31 (44.3%), and MS-TRAM in 19 (27.1%). Results:The volume of blood loss in the DIEP group was significantly higher than that in the DMS-TRAM group (328 ± 182 vs 454 ± 217 mL, p = 0.02), the other factors did not significantly influence. The rate of fat necrosis in DIEP tended to be high (10.0% vs 22.6%, p = 0.22). Conclusions:Because DMS-TRAM could preserve the deep muscle and penetrating side of intercostal nerve, it could be performed less sacrifice and there were few bleeding and partial necrosis at the same level as MS-TRAM. DMS-TRAM was effective in the applied cases.

The correlation of flap blood glucose with fat necrosis of free abdominal flap for unilateral breast reconstruction

“…Four patients underwent re‐exploration due to thrombosis at the anastomosis site. Four patients, including one patient who underwent re‐exploration, underwent intraflap crossover anastomosis for constructing bipedicled abdominal free flaps (Tokumoto et al, 2019a). Since these patients could not be evaluated equally, they were excluded from this study.…”

“…When the perforator diameter was wide and the perforator was in the appropriate layer, multiple‐perforator deep inferior epigastric perforator (DIEP) was performed. To ensure that the flap was elevated safely, a nerve‐sparing procedure was performed (Tokumoto et al, 2019a).…”

Impact of Rectus Muscle Injury during Perforator Dissection on Functional Donor Morbidity after Deep Inferior Epigastric Perforator Flap Breast Reconstruction

“…In cases with considerable rectus muscle injury, although no rectus muscle is harvested within the flap itself, the sequelae in the donor site may likely appear to be functionally similar with that of muscle-sparing TRAM flap harvest. 23 That is, all DIEP flaps may not be the same in terms of functional donor morbidity. 10 The width ratio of the injured muscle achieved maximal discrimination for the rate of functional weakness at a threshold value of 0.12.…”

The utility of free abdominal flap without Zone 4 procedure for unilateral breast reconstruction

“…When the perforator diameter was thick and the layer of the perforator running was excellent, we used DIEP (MS‐3). We performed a nerve‐sparing approach to ensure that the flap was elevated safely (Tokumoto et al, 2019).…”

“…The abdominal flap was harvested, including the fat flap bisymmetry (Figure 1). Connecting the bilateral deep inferior epigastric arteries by intraflap crossover anastomosis is one of the most popular methods for constructing bipedicled abdominal free flaps (Kim et al, 2016; Tokumoto et al, 2019). This procedure was performed for the patients requiring a large flap.…”