Effectiveness of lobulated pedicled rectus abdominis myocutaneous flap for repairing huge chest wall defect / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect.@*METHODS@#Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly.@*RESULTS@#All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis).@*CONCLUSION@#The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.

Reconstrucción de la pared abdominal con colgajo miocutáneo transverso de recto abdominal / Abdominal wall reconstruction with transverse rectus abdominis myocutaneous flap

Los defectos de pared abdominal son un desafío para los cirujanos plásticos. El sarcoma de partes blandas es muy recidivante y hay que hacer amplias exéresis con margen oncológico y como consecuencia quedan amplias zonas por reconstruir. El colgajo transverso de recto abdominal es una opción reconstructiva de esta región con buenos resultados estéticos y funcionales. El objetivo del trabajo es mostrar los resultados de la reconstrucción inmediata de la pared abdominal luego de una amplia exéresis oncológica. Se presenta una paciente femenina, mestiza, de 60 años, con diagnóstico de sarcoma de partes blandas, que abarcaba todo el hemiabdomen ínfero izquierdo hasta límites del reborde costal izquierdo, comprometía aponeurosis, el músculo recto izquierdo, y pequeña parte del peritoneo que se reparó. Se decidió una amplia exéresis y se planificó la reconstrucción con un colgajo miocutáneo transverso de recto del abdomen. Se utilizaron mallas de polipropileno. Se logró la reconstrucción inmediata del defecto oncológico con buenos resultados estéticos y funcionales(AU)

Abdominal wall defects are a challenge for plastic surgeons. Soft-tissue sarcoma is very recurrent and it is necessary to make extensive exeresis with oncological margin and, as a result, there are large areas to be reconstructed. The transverse rectus abdominis flap is a reconstructive option for this region and with good aesthetic and functional results. The objective of the work is to show the results of the immediate reconstruction of the abdominal wall after an extensive oncological exeresis. We present the case of a female patient, mestiza, aged 60 years, with a diagnosis of soft-tissue sarcoma, which encompassed all the left inferior hemiabdomen to the left costal margin limits, compromised the aponeurosis, the left rectus muscle, and a small part of the peritoneum that was repaired. A wide exeresis was decided and the reconstruction was planned with a transverse rectus abdominis myocutaneous flap. Polypropylene meshes were used. The immediate reconstruction of the oncological defect was achieved with good aesthetic and functional results(AU)

Spinopelvic Reconstruction with Femoral Allograft and Vertical Rectus Abdominis Myocutaneous Flap after Total Sacrectomy in Recurrent Sacral Chordoma: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of recurrent sacral chordoma treated with total sacrectomy and spinopelvic reconstruction. SUMMARY OF LITERATURE REVIEW: Sacral chordoma is a musculoskeletal tumor reported to have a low incidence. Surgical treatment is considered difficult due to the complicated sacropelvic structure, so the prognosis for patients with sacral chordoma has been considered poor. MATERIALS AND METHODS: We report a surgical technique and outcomes from spinopelvic reconstruction with femoral allograft and vertical rectus abdominis myocutaneous flap after total sacrectomy. RESULTS: We report no tumor recurrence at 43 months postoperatively. CONCLUSIONS: Spinopelvic reconstruction with thorough surgical planning after total sacrectomy was found to be a safe and effective treatment method.

Resección abdominoperineal isquioanal con reconstrucción de pared posterior de vagina con colgajo miocutáneo de músculo recto abdominal vertical / Ischioanal abdominoperineal resection with reconstruction of posterior wall of vagina with vertical rectus abdominis myocutaneous flap

El colgajo del recto abdominal miocutáneo vertical, es un excelente colgajo que rellena el gran defecto en la pelvis luego de una resección abdominoperineal isquioanal, siendo libre de tensión y reduciendo significativamente la incidencia de complicaciones de la herida perineal y la estancia hospitalaria, con el cual se puede reconstruir la pared posterior de la vagina. Se reporta aquí el primer caso en Costa Rica de una resección abdominoperineal isquioanal, con reconstrucción de pared posterior de vagina con colgajo del recto abdominal miocutáneo vertical, practicada con éxito en una paciente de 62 años, con un adenocarcinoma rectal localmente avanzado con infiltración de pared posterior de vagina.

Vertical rectus abdominis myocutaneous flap, is an excellent flap that fills the large defect in the pelvis after an adominoperineal ischioanal resection; it is free from tension, significantly reduces the incidence of perineal wound complications and hospital stay and can be used to reconstruct the posterior wall of the vagina. We report the first case of Costa Rica abdominoperineal ischioanal resection with reconstruction of posterior vaginal wall with vertical rectus abdominis myocutaneous flap, successfully practiced in a patient of 62 years with locally advanced rectal adenocarcinoma infiltrating posterior wall of the vagina.

Strategy of breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap / 中华医学美学美容杂志

Objective To investigate the availability and strategy of breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.Methods From January 2007 to May 2011,12 cases of breast reconstruction with caesarotomy scar were carried out with pedicled TRAM flaps.All the patients that were classified as the class Ⅱ that was 0.5 or less by score were operated on by using the inverted trapezoid incision,of which the upper edge was 2 or 3 cm down to the umbilicus.Double pedicles were adopted for the patient with the longest vertical scar; single pedicle of the breast contralateral side and the muscle sheath of the breast ipsilateral side were harvested for the rest of the patients.A synthetic mesh was used for the enforcement of the muscle and sheath defect.Results No flap necrosis or abdominal complications were observed.With the follow-up from 3 months to 4 years and 4 months,the overall satisfactory rate was 100 ％.Conclusions The strict patient selection and the operating strategy are the keys to the successful breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.

The Outcome of Radiation Therapy after Immediate Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction

PURPOSE: The safety of radiation therapy after breast reconstruction using transverse rectus abdominis myocutaneous(TRAM) flap is still being debated, and few studies exist on the outcome of irradiation after immediate TRAM breast reconstruction. Some authors presented satisfactory outcomes after adjuvant radiation therapy on reconstructed breast with pedicled TRAM flap, while others reported significant post radiation changes of the flap. Effect of radiation therapy on TRAM flap was evaluated to see whether adjuvant radiation therapy was tolerable. METHODS: 1000 immediate TRAM breast reconstruction was done by a single surgeon from July, 2001 to December, 2009. Among them 105 patients required adjuvant radiation therapy because of advanced disease or locoregional recurrence. Fat necrosis, radiation fibrosis, mastectomy skin flap necrosis, need for secondary touch up procedures, patient satisfaction were evaluated. RESULTS: The incidence of fat necrosis was 10.5% and significant radiation fibrosis occurred in only one patient. Delayed wound problem did not occur during or after irradiation. Secondary touch-up procedures were performed in 12.3%, the most common being fat graft(8.6%). Average patient satisfaction score was 8.62/10, which was not significantly different from the authors' previous report involving all the TRAM patients(8.50). CONCLUSION: Radiation therapy did not increase the complication rate significantly. Aesthetic result was affected but was tolerated in most cases. The fear of adjuvant radiation is not a negative factor in selecting immediate breast reconstruction with TRAM flap.

Correlation of Breast Tissue Density and Body Mass Index

PURPOSE: In performing breast reconstruction, making symmetrical breast is still a challenge. A precise estimate of the volume of the breast specimen is necessary to reconstruct a symmetrical and aesthetically pleasing breast. This study aims at finding out the relationship with breast tissue density and body mass index designed to apply for breast reconstruction. METHODS: By using the Archimedes' principle, the authors calculated the volume of the breast specimen and drew a correlation between the density of breast specimen and BMI. From October 2002 to November 2004, this method was used on 197 patients to predict breast volume for TRAM flap reconstruction. RESULTS: The mean density was 0.9954g/cc and had no correlation with BMI (p-value=0.069). There was no difference between denstiy of breast tissue after skin spared mastectomy and that of breast tissue after nipple spared mastectomy. CONCLUSION: These data will be helpful to predict the needed volume for breast reconstruction.

Clinical significance of muscle sparing verticle rectus abdominis myocutaneous flap for vaginal reconstruction / 中华医学美学美容杂志

Objective To evaluate the method for vaginal treconstruction with muscle sparing verti-cle rectus abdominis myocutaneous flap(MS-VRAM flap). Methods From September 2006 to April 2008, MS-VRAM flaps were used for vaginal reconstruction in 9 patients (20 to 35 years old), ancl all ca-ses were congenital absence of vagina. Before operation, the inferior epigastrie arteries were detected by the Doppler and the flaps based on the perforators ranged from 6 cm×20 cm. MS-VRAM flaps were ele-vated and then transferred to reconstruct the vagina. Results All 9 cases of MS-VRAM flaps survived completely. No complications occurred at donor site of abdominal wall. With 2-12 months' follow-up, the patients were satisfied with the results. Conclusion Despite technical difficulties in elevating the MS-VRAM flap, the flap is a good choice for vaginal reconstruction.

Simplified Insetting Strategy in Pedicled TRAM Flap Breast Reconstruction

Various method of insetting the transverse rectus abdominis myocutaneous flap for breast reconstruction has been reported in literature. The Bostwick's principle is commonly applied, which utilizes contralateral pedicle in a vertical or oblique flap inset position and ipsilateral pedicle in the transverse position. But it is relatively a complex and difficult technique, thus requires a more simplified strategy. We have formulated a new insetting method, in which the contralateral pedicled TRAM flap with an oblique(0 degree - 90 degrees) flap inset was carried out. We used this method in 100 cases from July 2001 to June 2003. This maneuver places Hartrampf's zones I and III with good vascularity in the medial side, and zone II in lateral side of breast. Fat necrosis was observed in 14 patients(14%) and of these, only three cases needed surgical excision. This simplified method is easy to learn. Specifically, fat necrosis removal is easy with more tolerable aesthetic results, especially in Asian patients with smaller breasts.

The Rectus Abdominis Myocutaneous Flap for the Immediate Reconstruction of Partial Vaginal Defects Following the Extended Abdominoperineal Resection of Recurrent Rectal Cancer

Extensive resection including posterior vaginal wall may be required for the advanced low rectal cancer or recurrent rectal cancer in order to achieve the tumor free circumferential margins. We describe closure of a vaginal defect with rectus abdominis musculocutaneous flap after extended abdominoperineal resection, hysterectomy and partial colpectomy in a patient with recurrent rectal cancer with the special reference to the surgical technique.

Breast reconstruction with the bipedical transverse rectus abdominis / 中华医学美学美容杂志

Objective To study the operational method and the clinical application of breast reconstruction with the bipedical transverse rectus abdominis. Methods 5 cases of breast reconstruction were performed with bipedical transverse rectus abdominis post mastectomy, and 3 cases of nipple-areola reconstruction. Immediate reconstruction was 3 cases, and delayed reconstruction was 2 cases. Results 4 cases of the breast reconstruction were survival, the morphologies were natural, and touch feeling was normal. Only one case skin flap was partial necrosis, nearly 3cm?2cm. Conclutions The breast reconstruction with bipedical transverse rectus abdominis is a good choice for breast cancer patients with caesarotomy scar.