Augmentation of Transmidline Skin Perfusion and Viability in Transverse Rectus Abdominis Myocutaneous (TRAM) Flaps in the Pig

Dorion, Dominique; Jb, Boyd; Cy, Pang

doi:10.1097/00006534-199110000-00014

Cited by 25 publications

(11 citation statements)

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“…18 With respect to the TRAM flap, there is an abundance of laboratory and clinical information that demonstrates the efficacy of the delay phenomenon in reducing flap necrosis. Several studies in the rat and pig [19][20][21][22] confirm marked increases in TRAM flap survival when the dominant pedicle is ligated prior to TRAM flap transfer (Fig. 1).…”

Section: Scientific Foundationsmentioning

confidence: 81%

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Surgically Delayed TRAM Flap: Scientific Foundations and Clinical Applications

Restifo¹

2000

Perspectives in Plastic Surgery

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The TRAM flap is a popular and versatile technique for autologous tissue breast reconstruction. Certain patient populations, however, remain at high risk of vascular insufficiency of the TRAM flap with the sequelae of flap necrosis and fat stiffness. One option to reduce the risk of TRAM flap vascular ischemic compromise is a preliminary surgical delay procedure. This article briefly reviews the scientific basis of the delay phenomenon and offers an algorithm for implementation of the delay procedure for TRAM flap breast reconstruction in clinical practice. Keywords Breast reconstruction, TRAM flap, delayed procedure, complicationsThe transverse rectus abdomini myocutaneous (TRAM) flap is an exceptionally useful technique for autologous tissue breast reconstruction, allowing reconstruction of virtually any size or shape of breast with unsurpassed aesthetic results. 1,2 Furthermore, the TRAM flap is not subject to the long-term issues of implant reconstruction, such as capsular contracture and implant failure. Despite these advantages, however, the TRAM flap is potentially plagued by marginal vascularity in the distal zones, with the sequelae of fat stiffness and flap necrosis. 3-7 This propensity toward vascular compromise is even higher in certain patient populations, such as obese, smoking, or irradiated patients.Increased recognition of the TRAM flap's potential for ischemic complications has led to the development of modifications of the TRAM flap. These modifications include the midabdominal TRAM flap, the double-pedicled 8 TRAM flap, and the microsurgical "supercharged" and "free" 9-11 TRAM

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Section: Scientific Foundationsmentioning

confidence: 81%

“…17,21,30,32 In clinical series published to date, the delay procedure is empirically performed between 1 week and 1 month prior to TRAM flap breast reconstruction. [25][26][27][28][29]32 Clinical data demonstrate increased SEA blood flow after 1 week, with perhaps further increases at 2 weeks.…”

Section: Timingmentioning

confidence: 99%

Surgically Delayed TRAM Flap: Scientific Foundations and Clinical Applications

Restifo¹

2000

Perspectives in Plastic Surgery

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“…However, if necrosis occurs, it usually takes place in this anastomotic zone. Perfusion pressure decreases, arteriovenous shunting occurs, and oxygen tension is subsequently lowered during the first 3-4 days, a process that leads to necrosis [18,19].…”

Section: Flap Circulationmentioning

confidence: 99%

Perforator Flaps: Principles and Techniques

Tenekeci¹

2018

Issues in Flap Surgery

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Evolution of flaps has continued after the introduction of fasciocutaneous and musculocutaneous flaps. Perforator flaps have evolved, and they have provided many new flaps with new pedicles all over the body presenting important advantages. Better understanding of vascular anatomy and pattern of skin circulation has become possible by numerous cadaveric studies. As a result, widespread use of perforator flaps, either pedicled or free, has become possible. Perforator flaps have provided freedom of flap design with over 350 perforators all over the body, reliability, and reduced donor site morbidity. However, success begins with planning and continues with operative procedure. Here, in this relatively new field of reconstructive surgery, the following are discussed: the correct planning of perforator flaps, microanatomy of perforators, and what to do during the operation based on previous reports. Lastly, some brief information and examples of perforator-based workhorse flaps are given.

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“…To study these variants, animal models were developed, including pigs 3 , mouses 4 and rats 5,6,7,8,9 . These animal models set the stage for further studies about the transverse rectus abdominis muscle flap.…”

Section: 2mentioning

confidence: 99%