The Extended Vertical Rectus Abdominis Myocutaneous Flap for Breast Reconstruction

Sakai, Shigemi; Takahashi, Hirokazu; Tanabe, Hiroko

doi:10.1097/00006534-198906000-00026

Cited by 24 publications

(7 citation statements)

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“…[4][5][6] Its use in filling complex perineal defects, however, was first described by Shkula and Hughes in 1984 7 and later popularised by Tobin and Day. 8 Due to its robustness, simplicity in execution and versatility, the RAM flap is now an established technique in the armamentarium of many colorectal and reconstructive surgeons across the uK.…”

Section: Since Miles First Described the Operation Of Abdominoperineamentioning

confidence: 99%

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

McMenamin

Clements

Edwards

et al. 2011

annals

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INTRODUCTION Perineal wound breakdown with delayed wound healing represents a significant cause of morbidity following surgery and radiotherapy to the perineum. The rectus abdominis myocutaneous (RAM) flap has been used increasingly to reconstruct the perineum with good effect. We describe our six-year experience of reconstruction of the perineum with the RAM flap and share some surgical adjuncts we believe are useful. METHODS We conducted a retrospective case note review of all patients who underwent a reconstruction of the perineum using the RAM flap between August 2003 and October 2009. Indications for the flap, complication rates and outcomes were all observed. RESULTS We conducted 16 RAM flap procedures, 15 of which (94%) were primary repairs and 1 (6%) a secondary repair. Three (19%) developed donor site hernias, two (12.5%) developed minor perineal wound infections, eight (50%) developed minor perineal wound breakdown and in one (6%) flap failure was observed. No perineal hernias were observed. There were no surgical mortalities. CONCLUSIONS The RAM flap has a high success rate and an acceptable morbidity rate and is a useful tool in the reconstruction of complex perineal wounds. Modifications to the standard surgical technique may reduce complications and improve the versatility of this flap.

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Section: Since Miles First Described the Operation Of Abdominoperineamentioning

confidence: 99%

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

McMenamin

Clements

Edwards

et al. 2011

annals

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show abstract

“…There are no doubts, however, that there is a measurable functional de cit in the abdomen after a TRAM ap (9,10) and that, while this de cit may not be a handicap for most patients during their daily activities and in their work, it could be responsible for problems that arise when the abdominal wall undergoes intense mechanical stress as during pregnancy. Some authors (13,15) felt that breast reconstruction using a myocutaneous ap made of the abdominal rectus muscle (TRAM ap) was an absolute contraindication to pregnancy. At present these statements have no foundation whatever, as Viterbo and De Luca (18) have shown that even after a TRAM ap it is possible to bear a child and tend to his daily needs without any major problems.…”

Section: Discussionmentioning

confidence: 99%

“…For some authors in the past (13,15), the desire to have children was a contraindication to TRAM ap breast reconstruction because it was thought that the abdominal wall, weakened by the rotation of one or both of its rectus muscles, would not be capable of withstanding the stress induced by pregnancy. On the other hand, there are several reports (1,3,8,18) that describe successful pregnancies after TRAM ap breast reconstruction without secondary hernias in the abdominal wall.…”

mentioning

confidence: 99%

Pregnancy And Tram-Flap Breast Reconstruction After Mastectomy: A Case Report

Parodi

Osti²,

Longhi³

et al. 2001

Scandinavian Journal of Plastic and Reconstructive Surgery and

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A 38-year-old patient had a right radical (Patey) mastectomy for an infiltrating ductal carcinoma followed by chemotherapy and, one year later, a TRAM flap breast reconstruction. She was given clear and exhaustive information about the possible consequences of pregnancy, but despite this she became pregnant four months after the reconstruction. The pregnancy was taken to term despite the appearance at four months of a slow-growing abdominal hernia. In the light of our experience and that of others, we recommend an interval of at least 12 months between breast reconstruction with a TRAM flap and pregnancy.

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“…In the long term (days to years), chronic ET-1 exposure may be detrimental, leading to hypertrophy and heart failure. Increased levels of circulating ET-1 and upregulation of ET receptors have been documented in failing hearts [7,8,9,10,11]. Identifying basic cellular mechanisms underlying the effects of ET-1 on Ca 2+ handling and contractility would provide a foundation on which to understand its acute physiological and chronic pathological roles in the heart.…”

Section: Introductionmentioning

confidence: 99%

PKC-ε mediates multiple endothelin-1 actions on systolic Ca2+ and contractility in ventricular myocytes

Kang

Chung

2012

Biochemical and Biophysical Research Communications

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Endothelin-1 (ET-1) induces positive inotropy (enhanced contractility) in cardiac muscle, but establishing underlying cellular mechanisms has been controversial in part because of a growing number of signaling pathways and end effectors targeted by ET-1. Here we present evidence that ET-1 induces positive inotropism in ventricular tissue by increasing both systolic Ca2+ and myofilament Ca2+ sensitivity. To examine the roles of PKC-δ and PKC-ε in these acute responses to ET-1, kinase inactive dominant negative PKC (dn-PKC) constructs were expressed in adult rat ventricular myocytes. Yellow fluorescent protein (YFP) was fused to dn-PKC constructs to visualize expression and localization of dn-PKC in living myocytes. Due to an alanine to glutamate mutation in the pseudosubstrate site, dn-PKCs constitutively translocated to anchoring sites and were unaffected by agonist or phorbol ester treatment. Dn-PKC-δ-YFP mainly distributed at Z-lines and at intercalated disks in adult myocytes, whereas dn-PKC-ε-YFP stained the surface sarcolemma, T-tubules/Z-lines and perinuclear region. Myocytes expressing dn-PKC-δ-YFP showed normal systolic Ca2+ and contractile responses to ET-1. In contrast, the entire ensemble of ET-1 responses was blocked in myocytes expressing dn-PKC-ε-YFP including increased Ca2+ transients, enhanced myofilament Ca2+ sensitivity, and positive inotropy. This report provides direct evidence that PKC-ε is activated early and robustly following ET-1 stimulation and thus mediates multiple intracellular changes underlying the acute actions of ET-1 on myocardium.

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The Extended Vertical Rectus Abdominis Myocutaneous Flap for Breast Reconstruction

Cited by 24 publications

References 0 publications

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

Pregnancy And Tram-Flap Breast Reconstruction After Mastectomy: A Case Report

PKC-ε mediates multiple endothelin-1 actions on systolic Ca2+ and contractility in ventricular myocytes

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