Potential problems with the transverse rectus abdominis myocutaneous flap in breast reconstruction and how to avoid them

Supercharged Free Transverse Rectus Abdominis Myocutaneous Flap: An Autologous Reconstructive Option for the Thin Breast Reconstruction Patient

The free transverse rectus abdominis myocutaneous (fTRAM) flap is a frequently used option for autologous breast reconstruction, typically based on deep inferior epigastric vessels anastomosed to either the axillary or internal mammary systems. The distal portion of the fTRAM flap is routinely discarded prior to anastomosis, due to tenuous blood supply in the vascular territory most distal to the pedicle. This becomes problematic in cases that require use of the entire flap, such as in thin patients with large soft-tissue defects. We report a case where an additional “supercharged” venous microsurgical anastomosis was successfully performed to minimize adverse events while utilizing the entire fTRAM flap.

"Turbo charging" the vertical rectus abdominis myocutaneous (turbo-VRAM) flap for reconstruction of extensive chest wall defects

We report our experience using "turbo charging" of the vertical rectus abdominis myocutaneous (turbo-VRAM) flap in 7 patients with extensive chest wall defects. The turbo-VRAM flap provides augmented blood supply with microvascular anastomosis between the inferior epigastric system and available vessels of the axillary, brachial or cervical vascular system. All patients in this study had uncomplicated recovery. In 3 patients, the skin paddle of the flap, which was designed as a fish shape, was effectively used to cover a wide defect. One patient required resection of some lower costal cartilages located near the superior epigastric vascular system in order to extend the rotation distance of the flap. These technical options have made the turbo-VRAM flap more versatile. The turbo-VRAM flap allows successful coverage of extensive chest wall defects, including defects of the axilla, upper arm, shoulder, or neck.

The use of myocutaneous flaps by general surgeons

This is a study of the use of myocutaneous flaps by general surgeons in a district general hospital over a 5 year period, and shows that such work can be satisfactorily performed by general surgeons.

Use of the rectus abdominis muscle flap in urological reconstructive procedures

The rectus abdominis muscle flap has been used successfully in 4 reconstructive procedures complicated by tissue loss or urinary fistula. This simple procedure is advocated as an alternative to the use of omentum when prior abdominal surgery precludes omental mobilization. No adverse functional nor cosmetic result to the abdominal wall resulted.

Anatomical basis of rectus abdominis myo-cutaneous flaps

The recent development of myo-cutaneous flaps and their use in plastic and reconstructive surgery prompted the authors to have a particular interest in musculo-cutaneous flaps of the rectus abdominis. From their personal studies and from a review of the literature, they consider the anatomical bases for these flaps and the different methods proposed for their construction. Finally they indicate their vast area of application which is essentially related to the wide range over which they can act.