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

Longo, Benedetto; D’Orsi, Gennaro; Pistoia, Angelica; Gagliano, Elettra; Vannucchi, Lisa; Natali, Gianluca; Ambrogi, Vincenzo; Cervelli, Valerio

doi:10.57604/prrs-028

Cited by 12 publications

(8 citation statements)

References 31 publications

(28 reference statements)

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“…The RA flap is pedicled by the superior epigastric artery and used for anterior to anterior-lateral chest wall defects. With a skin paddle, the vertical rectus abdominis myocutaneous (VRAM) flap, transverse rectus abdominis myocutaneous (TRAM) flap or T-inverted shaped rectus abdominis myocutaneous (Ti-RAM) flap can be appropriate ( 6 , 8 , 18 – 20 ).…”

Section: Discussionmentioning

confidence: 99%

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

Asanuma,

Tsujii,

Hagi

et al. 2024

Front. Surg.

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IntroductionMusculoskeletal transfer for chest wall tissue defects is a crucial method, and pedicled flaps around the chest wall are preferred in terms of location and simplicity of transfer. These require special care because of complications such as partial necrosis, fistula, wound dehiscence, infection, hematoma and restricted function of the arm or shoulder. However, studies of respiratory function are rare. In the present study, we investigated the complications including respiratory problems after wide resection for malignant chest wall tumors with musculoskeletal pedicle transfer.MethodsA total of 13 patients (15 operations) who underwent wide resection of primary, recurrent, or metastatic malignant chest wall tumors and musculoskeletal pedicle transfer for coverage of tissue defects were enrolled in the present study. A retrospective review of all patients was performed using data collected from hospital records and follow-up information. The complications of musculoskeletal transfer after chest wall wide resection, including respiratory problems, are evaluated.ResultsRib or sternal resection was performed in 12 operations, and only soft tissue resection was performed in 3 operations. Latissimus dorsi (LD) pedicle transfer was performed in 13 operations, and pectoralis major (PM) pedicle transfer was performed in 2 operations; basically, wounds were closed primarily. Surgical complications were observed following 5 of the 15 operations (33.3%). Respiratory complications were seen in 7 of the 15 operations (46.7%). Patients with respiratory complications showed significantly lower preoperative FEV1.0% values than those without respiratory complications (p = 0.0196). Skin resection area tended to be higher in the complication group than in the no complication group (p = 0.104).DiscussionPedicled myocutaneous flap transfers such as LD, PM, and rectus abdominus can be used following multiple resections. After harvesting LD or PM, the wound can be closed primarily for an 8–10-cm skin defect in patients with normal respiratory function. However, for patients with low FEV1.0%, after primary closure of LD or PM transfer for wide soft tissue defects, attention should be paid to postoperative respiratory complications.

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Section: Discussionmentioning

confidence: 99%

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

Asanuma,

Tsujii,

Hagi

et al. 2024

Front. Surg.

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“…Since its introduction, the FALD flap received outstanding attention because it represents a totally autologous reconstruction, is easy to harvest, and does not need microsurgical experience. [22][23][24] With the proper patient selection, this flap can guarantee a pleasant aesthetic outcome and adequate breast volume in a single operative session. 25 As a result, the FALD flap has become increasingly popular and utilized.…”

Section: Discussionmentioning

confidence: 99%

The Ergonomic FALD Flap for One-stage Total Breast Reconstruction

Longo,

D’Orsi,

Giacalone

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: The fat-augmented latissimus dorsi (FALD) flap combines this pedicled flap with immediate intraoperative fat transfer. Very little is described concerning its inset at the mammary site. Our efforts have concentrated on seeking the best flap orientation and skin-adipose paddle shaping, to improve the aesthetic outcome and to obtain a complete breast reconstruction (BR) in one stage. Methods: A prospective clinical study was performed in patients who underwent BR with FALD flaps, between December 2020 and March 2022. Patients were randomly enrolled into two groups: ergonomic inset of the FALD flap with vertical orientation of the skin-adipose paddle (group A) and FALD flap with traditional horizontal paddle orientation (group B). The study’s endpoints were the evaluation of the aesthetic outcomes (from patients’ and surgeon’s perspectives) and complications. Results: Thirty-two FALD flaps (23 patients) were performed for group A, and 31 FALD flaps (25 patients) for group B. The two groups were homogeneous in terms of demographic and surgical data (P > 0.05). The overall complication rate was homogeneous among the groups, without statistically significant differences (P = 1.00). The surgeon’s assessments showed a statistically significant superior aesthetic outcome in group A regarding volume, symmetry, and shape (P < 0.05). Higher satisfaction was observed in group A patients, in terms of breast size (P < 0.00001), shape (P = 0.0049), and overall satisfaction (P = 0.00061). Conclusions: The ergonomic vertical FALD flap technique enables surgeons to perform one-stage total BR, with excellent breast projection and upper pole fullness. These refinements in flap shaping and molding reduced the need for further autologous fat transfer, obtaining a brilliant totally autologous BR without the need for microsurgical experience.

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“…However natural anti-E autoantibodies may appear in patients with no known history of transfusion, nor pregnancy 17 . Given the severity and the extent of the defect, a free flap reconstruction was indicated [18][19][20][21] . The patient was informed on the risks inherent to the procedure and his hypercoagulable state and accepted to undergo the surgery.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical Reconstruction of Lower Extremity in Homozygosity of C677t MTHFR Gene Mutation: Case Report and Review of the Literature

Longo

Giacalone²,

D’Orsi³

et al. 2022

PRRS

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

Abstract: How to cite this article: Longo B, D'Orsi G, Pistoia A, et al. T-inverted shaped rectus abdominis myocutaneous (Ti-RAM) flap for chest wall reconstruction.

Cited by 12 publications

References 31 publications

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

Pedicled flap transfer after chest wall malignant tumor resection and potential risk of postoperative respiratory problems for patients with low FEV1.0%

The Ergonomic FALD Flap for One-stage Total Breast Reconstruction

Microsurgical Reconstruction of Lower Extremity in Homozygosity of C677t MTHFR Gene Mutation: Case Report and Review of the Literature

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