A Safe and Efficient Technique for Pedicled TRAM Flap Breast Reconstruction.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the indications for a unilateral pedicled transverse rectus abdominis (TRAM) flap-based breast reconstruction. 2. Understand the different types and designs of pedicled TRAM flap used in both immediate and delayed breast reconstruction. 3. Understand the essential landmarks and relevant anatomy of the pedicled TRAM flap. 4. Understand the steps of raising the pedicled TRAM flap, the subcutaneous transfer, and the insetting of the flap on the chest wall. 5. Understand the nature of donor-site management and closure of the defect. 6. Develop a postoperative plan for continuing care and pain management. SUMMARY: This article focuses primarily on the unilateral, ipsilateral pedicled TRAM flap. Although the bilateral pedicled TRAM flap may be a reasonable option in some cases, they have been shown to have a significant impact on abdominal wall strength and integrity. Other types of autogenous flaps using the same lower abdominal tissue, such as a free muscle-sparing TRAM or a deep inferior epigastric flap, can be performed as a bilateral procedure with less impact on the abdominal wall. Breast reconstruction with a pedicled transverse rectus abdominis flap has persisted for decades as a reliable and safe form of autologous breast reconstruction leading to a natural and stable breast shape.

Nursing Students' Perceived Disaster Preparedness and Response: Pilot study in Oman.

OBJECTIVES: This study aimed to assess the perceived level of disaster preparedness and response among nursing students in Oman, as the country is disaster prone and experiences disasters every three to five years. METHODS: A descriptive cross-sectional pilot study was conducted from May to June 2019 using a stratified cluster sampling method among nursing students recruited from two government nursing colleges in Muscat, Oman. The Disaster Preparedness Evaluation Tool and Disaster Response Self-Efficacy Scale were used to assess the knowledge, skill, disaster management and self-efficacy in handling disasters. RESULTS: A total of 51 students participated in this study. Most students (78.4%) had experienced a disaster while at home. Overall, the students had moderate levels of knowledge (3.17 ± 1.49), skill (3.12 ± 1.52), post-disaster management (3.22 ± 1.44) and self efficacy in responding to disaster (2.93 ± 1.16). CONCLUSION: Nursing students in Oman have experienced disasters and are willing to respond when called upon though they possess moderate knowledge and confidence in handling disasters.