Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh

Espinosa-de-los-Monteros, Antonio; Avendaño-Peza, Héctor; Novitsky, Yuri W.

doi:10.1097/gox.0000000000001014

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…In patients with DIEP flaps, the use of mesh in the repair of the abdominal donor site may also reduce the rate of postoperative abdominal bulge 14 . In previous studies on patients with autologous breast reconstruction using abdominal tissue, mesh has been placed in a variety of different positions, such as anterior (overlay) or posterior (sublay) to the rectus abdominis muscle or in a bridging position between the rectus abdominis muscles (inlay) 10,11,15,16 . However, the choice of mesh position has been determined by the preference of the surgeon, relying on personal experience and anecdotal evidence from published case series, as comparative studies investigating donor site complications among patients with different mesh positions have not been performed so far.…”

Section: Discussionmentioning

confidence: 99%

“…Wan et al 9 showed that the rate of abdominal bulging or hernia after MS-TRAM reconstruction without mesh was approximately 11% and was reduced to 5% when synthetic mesh was incorporated into the donor site repair, then being comparable with the rates observed in patients with DIEP flap reconstructions. A variety of different mesh positions in relation to the rectus abdominis muscle have been used to reinforce the donor site after MS-TRAM or DIEP harvest 10,11 . However, whether the plane of mesh placement has an impact on donor site complications in patients undergoing breast reconstruction with abdominal free flaps has not been investigated so far.…”

mentioning

confidence: 99%

“…A variety of different mesh positions in relation to the rectus abdominis muscle have been used to reinforce the donor site after MS-TRAM or DIEP harvest. 10,11 However, whether the plane of mesh placement has an impact on donor site complications in patients undergoing breast reconstruction with abdominal free flaps has not been investigated so far. The purpose of this study was to analyze donor site complications related to the position of mesh placement in patients undergoing breast reconstruction with MS-TRAM or DIEP flaps.…”

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confidence: 99%

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The Plane of Mesh Placement Does Not Impact Abdominal Donor Site Complications in Microsurgical Breast Reconstruction

et al. 2021

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Background Reinforcement of the abdominal wall with synthetic mesh in autologous breast reconstruction using abdominal free tissue transfer decreases the risk of bulging and herniation. However, the impact of the plane of mesh placement on donor site complications has not yet been investigated. Methods We performed a retrospective analysis of 312 patients who had undergone autologous breast reconstruction with muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps or deep inferior epigastric perforator (DIEP) flaps as well as polypropylene mesh implantation at the donor site. Donor site complications were compared among patients with different flap types and different mesh positions including overlay (n = 90), inlay and overlay (I-O; n = 134), and sublay (n = 88). Results Abdominal hernias occurred in 2.86% of patients who had undergone MS-TRAM reconstructions and in 2.63% of patients who had undergone DIEP reconstructions. When comparing patients with different mesh positions, donor site complications occurred in 14.4% of patients with overlay mesh, 13.4% of patients with I-O mesh, and 10.2% of patients with sublay mesh (P = 0.68). Abdominal hernias occurred in 4.44% of patients with overlay mesh, 2.24% of patients with I-O mesh, and 2.27% of patients with sublay mesh (P = 0.69). Multivariable logistic regression analysis did not identify a significant association between mesh position and hernia rates as well as wound complications. Conclusions Our data indicate that the plane of synthetic mesh placement in relation to the rectus abdominis muscle does not impact the rate of postoperative donor site complications in patients undergoing breast reconstruction with MS-TRAM or DIEP flaps.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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The Plane of Mesh Placement Does Not Impact Abdominal Donor Site Complications in Microsurgical Breast Reconstruction

et al. 2021

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“…In our case, we opted for the TRAM flap 21 , trying however to enlarge the skin envelope as much as possible using a T-inverted design, in order to cover the extensive loss of substance. Partial drawbacks of this flap are potential herniations, that could be overcome with adequate mesh positioning at donor site 22 .…”

Section: Discussionmentioning

confidence: 99%

T-Inverted Shaped Rectus Abdominis Myocutaneous (Ti-Ram) Flap for Chest Wall Reconstruction

Longo

D’Orsi

Pistoia

et al. 2022

PRRS

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“…[10,16,17] The use of mesh is demonstrated to reduce the risk of abdominal hernia and bulging. [11,[18][19][20][21] An extreme example of abdominal rupture following DIEP flap harvest is discussed by Iwabu et al [22] Authors report the patient required emergent surgery, which consisted of primary fascial repair with mesh overlay placement. [22] This series of patients also demonstrated a significant difference in the rates of polypropylene mesh and biologic mesh use.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics

Deptula¹,

Nguyen²

2021

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Background: In contrast to cosmetic abdominoplasty, abdominal flap harvest can result a high degree of morbidity to the abdominal wall. Poor abdominal wall aesthetics that can result following free flap harvest including a high abdominal incision and post-operative hernia or bulge. We report our experience in optimizing cosmesis of the abdominal donor site with the use of a low incision, fascial plication and routine mesh reinforcement. Methods: A retrospective chart review of patients who underwent breast reconstruction with free abdominal tissue transfer from 2013-2017. Pedicled flaps and superior inferior epigastric artery flaps were excluded. Patient demographics, oncologic history, ablative and reconstructive surgery details focusing on abdominal closure techniques, and postoperative complications were evaluated. Results: 135 patients were identified who underwent 223 abdominal free flaps. 59 (26.5%) DIEP flaps were harvested, while 160 (71.7%) msTRAM and 4 (1.8%) fTRAM flaps were harvested (p<0.0001). 160 (71.7%) donor sites closures utilized polypropylene mesh, 9 (4.0%) were closed with biologic mesh and 3 (1.3%) closures used no mesh (p<0.0001). No hernias were observed (0%), while 6 abdominal bulges were identified (2.7%). There were no differences in the rates of abdominal bulge after donor site closure in the DIEP compared with msTRAM and fTRAM groups (3.4% vs 2.4%, p=0.7). No patients required mesh explantation during the study follow up period. Conclusion: To parallel cosmetic abdominoplasty, our authors advocate for a low incision, fascial plication and routine mesh reinforcement of the abdominal wall following free flap harvest.

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Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh

Cited by 9 publications

References 22 publications

The Plane of Mesh Placement Does Not Impact Abdominal Donor Site Complications in Microsurgical Breast Reconstruction

The Plane of Mesh Placement Does Not Impact Abdominal Donor Site Complications in Microsurgical Breast Reconstruction

T-Inverted Shaped Rectus Abdominis Myocutaneous (Ti-Ram) Flap for Chest Wall Reconstruction

Abdominal Wall Closure in Autologous Breast Reconstruction: Optimizing Aesthetics

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