The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains a popular choice for patients requesting breast reconstruction. Criticism of all techniques that harvest the rectus abdominis muscle centre on abdominal wall weakness.[Dulin WA, Avila RA, Verheyden CN, Grossman L. Evaluation of abdominal wall strength after TRAM ...

Abdominal wound dehiscence is a serious complication of laparotomy, and fascial dehiscence in a patient with a stoma is especially difficult to manage. We describe how we performed local skin flap reconstruction for abdominal wound dehiscence in two patients with stomas. One patient underwent sigmoidectomy with a ...

To find an alternative to synthetic mesh closure of abdominal fascial defects after transverse rectus abdominis musculocutaneous (TRAM) flap harvest, dermal autografts were removed from tissue to be discarded and used for fascial closure. Dermal grafts have been used for herniorrhaphy and ...

Closure of fascia after transverse rectus abdominis myocutaneous (TRAM) flap has usually been performed with direct closure or synthetic material. The dermal autograft removed from zone IV of the flap is an alternative to reinforce fascial closure. Record of the patients who had been undergone breast and head and neck reconstruction by ...

Reestablishing anterior rectus fascial integrity remains a clinical challenge after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The main concerns include herniation and bulging due to abdominal weakness. Mesh-assisted closure of the fascial defect has improved bulging and herniation ...

The authors retrospectively reviewed the computerized records of 71 women undergoing 80 deep inferior epigastric perforator (DIEP) flap reconstructions after mastectomy over a 1-year period. There were 33 normal, 26 overweight, and 12 obese patients. No statistically significant difference in flap complications was found between groups. Overall fat ...

To determine the best method for preserving abdominal-wall integrity after TRAM flap breast reconstruction, the records of 130 patients followed for at least 6 months (mean 18 months) were examined. Three strategies for management of the abdominal-wall repair were compared. In the first group (72 patients), the entire width of the ...

Planned ventral hernia is a management strategy in which the abdominal fascial layer has been left unclosed and the viscera are covered only with original or grafted skin. Leaving the fascia open can be deliberate or unavoidable and most commonly results from staged repair of the abdominal wall due to trauma, peritonitis, pancreatitis, ...

The dorsalis pedis fasciocutaneous flap has been used successfully in soft tissue reconstruction both as a pedicled and a free flap. The long-term donor site problems associated with this dorsalis pedis flap prompted us to look at the use of the dorsalis pedis fascial flap in soft tissue ...

This technique has evolved over 13 years and has been associated with very few mesh-related complications. A recently reported study of 65 consecutive patients with a mean follow-up of 47.4 months reported a hernia rate of 1.5% (1 of 65) and an incidence of mesh-related infection of 1.5% (1 of 65). It appears that the use of polypropylene (Marlex mesh) offers the reconstructive surgeon several ...

BACKGROUND:: Although the combined petrosal approach has significant advantages for medium to large petroclival lesions, it carries the risk of a few major complications. The cerebrospinal fluid (CSF) leak rate with this approach has been reported to be as high as 15%. OBJECTIVE:: The authors describe an innovative technique of watertight dural closure utilizing a long microplate-bridge technique ...

Background: The pedicled or free temporoparietal fascial has been used in many areas, especially in head and neck reconstruction. This thin, pliable, highly vascularized flap may be also transferred as a carrier of subjacent bone or overlying skin.Objective: The aim of this study is to report our experience in versatile use of temporoparietal ...

Successful ear reconstruction depends on two factors: an ear framework and the skin covering the framework. However, the relative deficiency of skin for coverage of the cartilage framework remains an issue. This new method for total auricular reconstruction is a three-stage operation and involves the use of two tissue expanders. First, two skin expanders are implanted, one underneath the scalp and ...

We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

Considering the abundant vascular anastomotic networks in the deep fascia of the posterior calf, three kinds of distally based facial flap containing deep fascial vascular network were applied clinically. They were: 1. posterolateral distally based island fascial flap which could be used to repair the skin defect ...

Compression of the peripheral nerves (PNs) induces intraneural lesions, which, once surgical decompression has been achieved, requires that the peripheral scar tissue be as non-adherent as possible. This allows optimal nerve tissue regeneration and the flexibility necessary for longitudinal movements of the PNs. In cases showing a risk for adherence, tissue interposition (with fat, muscle, fascia, ...

Variable reconstruction methods for craniofacial tumour resections have been devised with the primary purpose to improve quality of life and disease control. The reconstructive aims are to provide a watertight seal, cranial base support while allowing a cosmetically pleasing result. For defects involving the orbit, maintenance of the depth of the orbital socket remains important for prosthetic ...

In April 2003, the author presented the use of the common peroneal tendon sheath as a vascularised fascial flap serving to cover exposed Achilles tendons in four patients. This flap was referred to as the peroneal tendofascial flap. The gross anatomy and blood supply of the tendon sheaths in the extensor ...

To define the long-term abdominal consequences of the TRAM flap procedure, 150 consecutive patients were evaluated 5 to 7.5 years postoperatively. Of 137 surviving patients, 135 (98.5 percent) returned a questionnaire (68 single pedicle, 63 double rectus harvest, and 4 single pedicle with contralateral microvascular augmentation) and 132 (96.4 percent) ...

During conventional reconstruction of the auricle in patients with microtia, simply separating the auricle from the mastoid region with a full-thickness skin graft usually fails to create firm elevation and sufficient projection. To achieve frontal symmetry is difficult, and sometimes the normal auricle needs to be set back. We reconstructed the auricle in patients with microtia in two major ...

Objectives: Upper extremity reconstruction presents a functional and aesthetic challenge in plastic surgery. Exposure of vital structures often requires vascularized soft tissue coverage to achieve primary wound healing and optimize functional results. Specifically, the serratus fascial flap may satisfy the functional and cosmetic requirements for small- ...

The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this ...

The temporoparietal fascial flap (TPFF) is a vascularized pedicle flap commonly used in head and neck reconstructions. The authors describe the use of a TPFF in repairing a large traumatic middle cranial fossa CSF fistula via a middle cranial fossa approach. During the 18-month follow-up, the patient had no further CSF leakage or ...

Two cases of successful reconstruction of massive defects around the knee with multiple-island combined flaps based on the subscapular axis are reported. Both defects resulted from aggressive debridement for acute osteomyelitis after open fixation of high-energy fractures around the knee. In Case 1, a four-island combined flap consisting of the scapular ...

... bilaterally, defining the limits 14 x 12 cm) of the proposed skin flap donor ... The pig was skinned after the gelatin had solidified and the abdominal pelt ...

ObjectiveTo examine donor-site complications after omental harvest for the reconstruction of extraperitoneal wounds and defects.Summary Background DataThe omentum, with its immunologic and angiogenic properties, is a versatile organ with well-documented utility in the reconstruction of complex wounds and defects. However, the need for laparotomy and the potential for intraabdominal complications ...

Abdominal wall complications of TRAM flap breast reconstruction are well described. Synthetic mesh abdominal reinforcement is believed to decrease the incidence of these complications. An innovative technique with commonly available suture anchors has been used in a case of recurrent abdominal laxity after a TRAM ...

The aim of this article is to report the application of expanding retroauricular skin fascia flap, and autogenous costal cartilage for congenital microtia reconstruction. Microtia reconstruction was generally completed in 3 surgical stages. In the first surgical stage, a 50 or 80 mL kidney-shaped tissue expander was inserted subcutaneously in the retroauricular mastoid region. ...

We present a pilot report of "banking" the contralateral hemi-abdominal deep inferior epigastric perforator (DIEP) flap under the abdominal closure in patients undergoing unilateral autologous breast reconstruction when a hemi-abdominal flap suffices. Four patients undergoing unilateral ...

Background:The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage.Materials and Methods:From 2004 to 2009, ...

We present reconstruction of a wide anterior abdominal defect measuring 30 x 45 cm(2), the result of necrotising pancreatitis. After serial debridements and reconstruction of the peritoneum using a Prolene mesh support, a delayed extended groin flap was transposed. No complications were encountered afterwards. An extended groin flap ...

The goal of reconstruction of the skull base is to repair dural defects with a watertight seal and separate it from the nasopharynx and the exterior environment with well vascularised tissue. This prevents cerebro-spinal fluid leakage and secondary contamination leading to the potentially life threatening complications of meningitis or extradural abscess. Following large composite resections, ...

Abdominal wall competence is a major concern of all plastic surgeons using the TRAM flap for breast reconstruction. Low hernia rates and adequate abdominal stability are standard expectations in abdominal wall closure. Described here is this institution's experience with the use of a large piece of synthetic mesh ...

Abdominal fascial closure after midline laparotomy can be time-consuming and inaccurate and is a common time for needle-stick injuries. The SuturTek 360 degrees Fascial Closure Device (FCD) is designed to provide a secure fascial closure while reducing the risk of needle-stick injury. To date, the accuracy and ...

The open abdomen is increasingly used for the treatment and prevention of abdominal compartment syndrome. The leading non-traumatic conditions that may cause abdominal compartment syndrome requiring surgical decompression include secondary peritonitis, ruptured abdominal aortic aneurysm and severe acute pancreatitis. Patients may also ...

Postoperative intra-abdominal hypertension (IAH) is a frequent occurrence in critically ill patients operated on for severe abdominal trauma, secondary peritonitis or ruptured abdominal aortic aneurysm. IAH may progress to abdominal compartment syndrome (ACS) with new-onset organ dysfunction. Early recognition of ...

A full-thickness defect of the abdominal wall is rare and may occur as a complication of extended abdominal surgery procedures. We report about a 69-year-old patient who was presented to our department with a full-thickness abdominal wall defect and a fully exposed collagen-mesh for reconstructive wound closure. 13 operations with ...

This article reports a case of re-elevating a prior vertical rectus abdominis musculocutaneous flap as a deep inferior epigastric artery perforator-based propeller flap to cover a recurrent chest wall defect. This case demonstrates that a conventional musculocutaneous flap tissue with a preserved perforator can be recycled as a ...

BACKGROUND:?Abdominal vacuum therapy has simplified the treatment of a laparostoma. But is that all that it can achieve? The role of abdominal vacuum therapy concerning the development of small bowel fistulas is still under discussion. Treatment of the bowel surface seems to be crucial for the prevention of fistulas. As military surgeons, we need a simple, ...

BACKGROUND: The repair of complicated abdominal hernias remains a challenging problem. The components separation technique introduced by Ramirez et al. is an increasingly popular method for autogenous reconstruction of the abdominal wall, especially in combination with epifascial mesh reinforcement. PATIENTS AND METHODS: In a retrospective study carried ...

Postoperative omental and bowel entrapment secondary to incisional hernias and life-threatening hemorrhage secondary to anterior abdominal wall bleeding may occur during cannula placement. The Carter-Thomason needle suture passer was used to correct 20 fascial and peritoneal cannula defects and 7 severe anterior abdominal wall ...

Pedicled flaps distant from the trunk are often used to reconstruct defects of the upper extremity. For this, various flaps have been described, with the groin flap being the most common. Recently, perforator flaps and perforator-based pedicled flaps have been described, that can be raised from ...

Breast reconstruction using the lower abdominal free superficial inferior epigastric artery (SIEA) flap has the potential to virtually eliminate abdominal donor-site morbidity because the rectus abdominis fascia and muscle are not incised or excised. However, despite its advantages, the free SIEA flap for breast ...

This study is designed to evaluate the effect of abdominal quilting sutures on the incidence of abdominal seroma formation in patients undergoing pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction. It is theorized that the use of such sutures during closure of abdominal ...

of using flaps on a vertical fin for rudder steering, the conventional tail was fixed to the end torques. These insects used lateral abdominal deflections aerodynamically for rudder steering7II,11 Micro Bat12 ) utilize rigid body joints such as rudder and elevator control flaps for torsional

INTRODUCTION: Despite herniorrhaphy being performed frequently, most surgeons consider it to be a minor procedure. However, a few surgeons' views differed. THE PAST: The Master was Bassini (1884), who introduced a radical cure for inguinal hernia. Incising his triple layer, internal oblique, transversus, and transversalis, he entered the preperitoneal space, allowing high ligation of the sac and ...

BACKGROUND: Deep inferior epigastric artery perforator (DIEP) flap has proved to be an effective method in perineal reconstruction. However, a few literatures have reported thinned DIEP flap which yields a better functional and cosmetic result. There are also no clear guidelines on the degree to which a DIEP flap may be debulked of ...

A new extended external oblique musculocutaneous flap utilized in the reconstruction of chest-wall defects is described. The flap is drawn as a V-Y rotation flap on the ipsilateral abdominal wall. It is laterally based, and its pedicle coincides with the five lowest costal insertions of the external oblique. The ...

The transverse rectus abdominis myocutaneous (TRAM) flap is ideal for postmastectomy reconstruction but is tenuous in morbidly obese patients. Because of their relatively high incidence of postoperative complications, morbidly obese patients are often not considered candidates for autogenous reconstruction. The midabdominal TRAM flap has a more favorable ...

Surgically delaying a unipedicled lower abdominal transverse rectus abdominis musculocutaneous (TRAM) flap has been shown to improve flow within the flap. This delay, however, also affects blood supply and drainage of the entire anterior abdominal wall. The purpose of this study was to compare the ...

When the free TRAM flap was introduced for breast reconstruction, it was supposed to have many advantages over the pedicled TRAM flap: good perfusion of all four zones, better mobility and easier shaping of the breast, lower incidence of abdominal-wall complications, and less restrictive selection of patients. However, we have ...

Free TRAM flap breast reconstruction was performed in 23 patients from july 1993 through november 1995 at the Saint-Louis Hospital in Paris. The surgical team was composed of eight different surgeons. In all cases a delayed breast reconstruction procedure was performed. All patients in this series had previously received radiation therapy and 82.6% patients presented with ...

Skull-base surgery is associated with a high risk of cerebrospinal fluid (CSF) leak, infection, and functional and aesthetic deformity. Appropriate reconstruction of cranial-base defects following surgery helps to prevent these complications. Between March 1998 and May 2000, 28 patients (age: 1-68 years) underwent reconstruction of the anterior and middle cranial fossae. The indications for ...

Harvesting the rectus abdominis myocutaneous flap results in defects in both the rectus abdominis muscle and the anterior rectus sheath, which may be circumvented by dissecting a perforator flap (DIEP flap) instead. However, the latter is associated with a reduction in the number of myocutaneous perforators nourishing the ...

The principle of the V-Y advancement flap has been used since its first description by Blasius (1848) for reconstruction of smaller defects. We wish to describe V-Y advancement flaps, the design of which includes distinct perforator or fascial feeder vessels, which may originate from periosteum, muscle, cutaneous nerve or from large ...

BACKGROUND:: The 180-degree propeller flaps allow closure of soft-tissue defects of the distal lower extremity. In addition to twist, the pedicle is often subject to additional kinking which increases proportional to the angle at which the perforator pierces through the fascia. This study evaluates the directionality of the perforators at the fascial level ...

BACKGROUND:: Reconstruction of the skull base is essential to prevent postoperative leakage of cerebrospinal fluid (CSF). However, a reliable method of reconstructing the middle cranial fossa via a subtemporal keyhole is not available. OBJECTIVE:: To determine whether less invasive reconstruction of the middle cranial fossa under endoscopic guidance using a pedicled deep temporal fascia approach ...

Occasionally surgeons have to operate on patients who have had previous abdominal or pelvic operations and irradiations for malignancies. Bowel resection with primary anastomosis under these circumstances is fraught with major complications such as anastomotic breakdown with intra-abdominal sepsis or recurrent enterocutaneous fistula, which are refractory ...

In the years 1983-1997, 252 female to male transsexuals were treated in the Department of Plastic Surgery of University Medical School in ?�d?. In 209 patients surgical penis construction was performed. The paper presents operative techniques and results of penis construction with the use of four kinds of flaps: a bipedicled abdominal tube ...

We present the deep femoral artery perforator (DFAP) flap, a new perforator flap for breast reconstruction, with a detailed description of operative technique and four clinical examples. The DFAP flap allows harvest of tissue from the lower buttock and lateral thigh with similar territory to an in-the-crease inferior gluteal artery ...

Abdominal wall reconstruction in omphalopagus twins poses a difficult reconstructive challenge, as separation often results in a large abdominal wall defect. A number of options are available for closure, including tissue flaps, expanders and patches made of foreign material. Surgisis is a new biodegradable small intestine scaffolding ...

Since the mid-1990s the surgical community has seen a surge in the prevalence of open abdomens (OAs) reported in the surgical literature and in clinical practice. The OA has proven to be effective in decreasing mortality and immediate postoperative complications; however, it may come at the cost of delayed morbidity and the need for further surgical procedures. Indications for leaving the abdomen ...

Recurrence of hydatid cyst is one of the important complications of primary hydatid surgery. Here we present a very rare case of recurrent hydatid cyst inside an incisional hernial sac. A 50-year old male operated on for hydatid disease of the liver twice in 1998 and 2001 was admitted to our hospital for an abdominal mass formed under the old median incisional scar. On ...

The purpose of this study was to investigate sensory recovery in 33 patients who underwent conventional mastectomy, skin-sparing mastectomy, or nipple-sparing mastectomy with immediate breast reconstruction using abdominal flaps. Reconstructions included a pedicled transverse (28 cases) or vertical (five cases) rectus abdominis musculocutaneous ...

The antigravity muscles of the lumbo-pelvic region, especially transversus abdominis (TrA), are important for the protection and support of the weightbearing joints. Measures of TrA function (the response to the postural cue of drawing in the abdominal wall) have been developed and quantified using magnetic resonance imaging (MRI). Cross-sections through the trunk allowed ...

AIM: To present our trial using a combination of the human acellular dermal matrix (HADM) implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection.METHODS: Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor ...

Loss of abduction power is a common problem after total hip arthroplasty (THA) and may lead to severe limp and instability. A surgical reconstruction technique using a gluteus maximus flap transfer was developed to repair deficient abductor muscles and capsule. The gluteus maximus muscle was split as in a posterior approach to the hip, and the anterior portion of the muscle ...

Abdominal wall function is a major concern for plastic surgeons performing breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore, preserves adequate abdominal wall competence. Between ...

The development of microsurgical breast reconstruction has resulted in not only the lower abdomen as a source of donor site tissue but also interest in alternative donor sites. These have included perforator-based flaps at the sites of previously described myocutaneous flaps (e.g., superior or inferior gluteal arteries) and the use of myocutaneous ...

IntroductionBreast reconstruction with autologous tissue transfer is now a standard operation, but abnormalities of the abdominal wall contour represent a complication which has led surgeons to invent techniques to minimize the morbidity of the donor site.Case presentationWe report the case of a woman who had bilateral transverse rectus abdominis myocutaneous ...

Multiple techniques have been employed for the repair of abdominal incisional hernias with varying rates of success. Primary fascial apposition and prosthetic implantation have been associated with high rates of secondary recurrence, infection, and other complications, often due to insufficient alleviation of tension and implant intolerance. This study ...

OBJECTIVES:: Abdominal wall reconstruction continues to evolve with improvement in technique and technology. This study reviews our experience with challenging full thickness (skin, muscle, and fascia) defects following tumor resections often in high-risk patients. METHODS:: All patients who underwent abdominal wall reconstruction following full thickness ...

The authors present a simple technique for restoration of the umbilicus in abdominal dermolipectomy. This procedure is represented by a double-Y cutaneous incision on the abdominal skin and by a double-M cutaneous incision on the umbilical skin. This technique restores a neoumbilicus with multiple small skin flaps and conceals the ...

The lower abdomen continues to be the favourite donor site for free tissue transplantation in autologous breast reconstruction. The deep inferior epigastric artery (DIEP)-flap has revolutionised microsurgical reconstruction of the breast after mastectomy. However, previous abdominal operations with resulting subcostal scars limit the use of this ...

With improved detection and genetic screening for breast cancer, increasing numbers of patients are choosing mastectomy and immediate breast reconstruction. Advances in breast reconstruction and mastectomy techniques over the last 25 years have increased expectations for breast reconstruction. The purpose of this review is to describe the role of the pedicled transverse rectus abdominis muscle ...

This study evaluated the recipient and donor site complications associated with breast reconstruction using a deep inferior epigastric artery perforator flap (DIEAP) flap compared with a free TRAM flap. The charts of 108 patients who underwent breast reconstruction using these techniques were reviewed. There were 130 ...

The etiology of lower abdominal bulge following breast reconstruction with the DIEP flap is uncertain. Most studies report an incidence that ranges from 0.7% to 5%. The purpose of this study was to review a set of factors that may predispose to a lower abdominal bulge. This was a retrospective review of 123 women who had breast ...

Repair of large abdominal wall defects is a challenge, particularly when full-thickness tissue loss prohibits coverage of the fascial repair. Two novel synthetic materials (TMS-1 and TMS-2) have been shown to be better accepted than expanded polytetrafluoroethylene (Gore-Tex), and polypropylene (Marlex) in the closure of clean and contaminated ...

Background:The pedicled TRAM flap has been a workhorse of autologous breast reconstruction for decades. However, there has been a rising concern about the abdominal wall donor site morbidity with the use of conventional TRAM flap. This has generally been cited as one of the main reasons for resorting to ...

The abdominal KUB (Kidneys, Ureters, and Bladder, also sometimes referred to as 'Flat Plate') demonstrates a smooth, large, calcific opacity in the left lower quadrant (see figure 1). An enteric tube is also noted with its tip in stomach; surgical staples...

Anomalies of the deep circumflex iliac artery do occur, although they are uncommon. Recently, two cases of these anomalies were encountered by the authors during elevation of iliac osteocutaneous free flaps. In the first case, the deep circumflex iliac artery was absent, and the nourishing artery of the flap was instead connected to the large iliolumbar ...

Because omental flaps are useful for flap prefabrication and the cambium layer of the periosteum can be osteogenic, we examined whether calvarial periosteum grafted onto greater omentum of rat was osteogenic and suitable for a flap. Distal omentum was wrapped with calvarial periosteum and so the cambium faced the omentum. Grafted ...

Following unilateral iliac artery injection of radiopaque Microfil in cadavers, coronal sections of the anterior abdominal wall at 1-cm intervals were obtained employing computerized axial tomography of the intact specimen as well as xerography of frozen slices. Because they avoid the distortion and disruption of the vasculature induced by anatomical dissection, these studies ...

Prevention of hernia or bulge of the abdominal wall after TRAM breast reconstruction has been a challenge for the reconstruction surgeon. Different techniques have been described to avoid this complication. The use of anterior rectus abdominis sheath (ARAS) for the repair of various abdominal wall hernias has been well described in the literature and is ...

Breast reconstruction with transverse rectus abdominis muscle (TRAM) flap raises two contradictory questions: the vascular safety of the flap and the late abdominal wall sequellae. In order to analyse these sequellae, 71 patients with TRAM flap breast reconstruction at the Institut Curie had a late postoperative ...

BackgroundAlthough multiple strategies for autologous breast reconstruction exist, a vertical midline scar in the abdominal wall as a result of previous laparatomy or abdominoplasty represents a major surgical challenge. To date, little research has been conducted on the regeneration potential of the abdominal wall�s superficial vascular, perforator and ...

Salmonella enterica serotype Enteritidis was detected in a 34-year-old, previously healthy patient who suffered from osteomyelitis of the costae. Radical surgical debridement and antibiotic therapy were able to stop the infection. An abdominal flap and a thoracic flap were used to cover the soft tissue defect. PMID:21826496

Abdominal wall herniation is a relatively rare but well recognized complication that is known to occur following TRAM flap mobilization. Herein is presented a novel means to approach such a hernia, using the minimally invasive surgical approach to repair the defect with a piece of prosthetic material. PMID:9774021

A case of successful reconstruction of the umbilicus using a depressed scar in an 11-year-old girl with a large and rigid scar spreading around the centre of the abdominal wall is presented. The anatomical umbilicus was replaced by a large scar after a previous surgery for umbilical cord hernia. The difficulty of the conventional method compelled us to use a distant scar ...

When forming a deep umbilical depression for paediatric patients displaying a thin layer of abdominal fat, the V-Y advancement flap method is useful. However, although many plastic surgeons approve of a longitudinal umbilical depression as an ideal, conventional flap methods often result in only a longitudinal scar line with a ...

BACKGROUND: The authors propose here a new strategy to obtain exceedingly expanded retroauricular mastoid skin for sufficient coverage of the three-dimensional autogenous costal cartilage framework generally used in auricular reconstruction surgery. From February 2000 to September 2009, 42 microtia reconstructions were performed using this new strategy. METHODS: Auricular reconstruction was ...

During recent years, clinical research on the donor site morbidity after free or pedicled transverse rectus abdominis myocutaneous (TRAM) flap surgery has been focusing on the reduced flexion capacity of the abdominal wall. However, the rectus abdominis muscles have close interactions with their synergists and antagonists and collaborate with their ...

Muscle sparing TRAM flaps and DIEA perforator flaps are standard procedures for breast reconstruction. Recently CT-angiography has been established to evaluate perforator vessels pre-operatively. CT-angiography was introduced to our department in July 2009. In a retrospective analysis data of the last 20 patients (altogether 22 flaps) ...

BACKGROUND: Recent experience with the ipsilateral TRAM flap has shown that it has the advantage of a longer functional pedicle length, which allows tension-free inset of well-vascularized tissue into the breast pocket. This leads to better positioning and shaping of the reconstructed breast with minimal disruption of the inframammary fold. The purpose of this article was to ...

BackgroundHyperthermic chemotherapy applies thermal energy to both abdominal wall as well as the intra-abdominal viscera. The combination of the hyperthemia, chemotherapy and cytoreductive surgery (CRS) is associated with a defined risk of abdominal wall and intestinal morbidity reported to be as high as 15%, respectively to date, no ...

The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of ...

The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of ...

The authors describe the case of a 52-year-old man with a history of supra-annular mechanical aortic valve replacement who presented with fever and abdominal pain. He was found to have an abdominal wall abscess. Subsequent transesophageal echocardiography revealed dehiscence of his mechanical aortic valve, supporting a diagnosis of prosthetic valve ...

It has been shown that the membranous layer of the subcutaneous tissue, known as Scarpa's fascia, is confined to an oval area on each side of the abdominal wall. By its attachment to the deep fascia it encloses an obliquely directed oval sac which extends into the perineum by three pocket-like diverticulae. The fascial extension which forms the pockets is ...

In view of the good results of breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap, we used this method in 48 patients, but we observed abdominal complications, which are difficult to accept for cosmetic surgery. Hartrampf, one of pioneers of this technique, reports a very low complication, rate by closing the ...

Abdominal bulging is a relatively common complication after autologous breast reconstruction using abdominal tissues. These are usually managed conservatively for a few months before operative treatment, which consists of reinforcing the rectus sheath either using prosthetic materials or by fascia plication. Postoperative abdominal ...

BACKGROUND: The open abdomen (OA) is a severe disease pattern accompanied by high morbidity and mortality. It is either result of a surgical dis-ease or approach. The aim of this review article is to provide a systematic overview on the op-tions of a temporary closure of the abdominal wall including early and late consequences in the treatment of an open abdomen based on the ...

Over the past 30 years, surgical specialties have introduced and expanded the role of open abdominal management in complicated operative cases, necessitating an intensivist's understanding of the indications and unique intensive care unit (ICU) issues related to the open abdomen. When presented with the open abdomen, resuscitation to correct shock is of primary concern. This ...

PURPOSE: We aimed to compare the effectiveness of experimental middle hernia defect repair in regard to the transverse and longitudinal positioning of anisotropic lightweight surgical mesh. METHODS: The mechanical properties of fascial layers and surgical mesh DynaMesh(�)-PP Light were determined in two perpendicular directions under uniaxial tension. In 12 male Wistar rats, ...

The transverse rectus abdominis myocutaneous (TRAM) flap can create a good breast shape, however, the patchwork-like scar obviously shows that the breast has been reconstructed. To reconstruct a breast without the patchwork-like appearance, we used a two-stage procedure using a tissue expander before transplanting a de-epithelialised TRAM flap. In ...

The authors report the successful repair of large lower abdominal hernia defects after transverse rectus abdominis muscle (TRAM) flap breast reconstruction in 11 patients using a technique of intraperitoneal application of synthetic polypropylene (Prolene) mesh anchored to the peritoneal surface of the abdominal wall tissues. Five of ...

With the increasing use of preoperative imaging of the abdominal vasculature prior to free flaps based on the abdominal wall, the identification of a previously undescribed anatomic structure has, that of large-vessel (macroscopic) arteriovenous communications, has emerged. These macrovascular arteriovenous shunts are observed in most ...

In 1990 the authors reported their preliminary study of the prevention of Frey's syndrome in 55 patients utilizing a superficial musculoaponeurotic system (SMAS) flap in parotid gland surgery. During the past 10 years, numerous studies have supported their original thesis that interposition of living tissue between the resected gland bed and the skin could prevent the ...

Modern ear surgery aims at obliterating the extensive radical cavities that remain after removal of a cholesteatoma. A wide variety of techniques have been developed, including working with muscle fascial flaps, cartilage or bone chips; osteoplastic meato-atti++----+-coantrotomy; reconstruction of the posterior auditory duct wall by ceramic dish moulds or ...

A rare case of urethral construction using flipped anterior bladder wall tube in an 8-year-old girl with complete disruption of the urethra and vagina accompanying pelvic fracture was reported. Following a split of the pubic symphysis, the vagina was reconstructed with end-to-end anastomosis. The neourethra was constructed tubularizing and flipping anterior bladder wall flap ...

Preoperative Doppler ultrasonography for planning free perforator flaps is widely established to identify preoperatively perforators. The method allows one to localise the penetrating point of the perforator through the abdominal fascia. By this means it is not possible to see the intramuscular course or the position of the perforator in relation to the ...

Free radicals and other toxic oxygen species play a role in the pathogenesis of ischemic organ damage. The abdominal skin flap has been used as a model to study the effects of superoxide dismutase on the survival of ischemic skin. We have evaluated the evolution of functional and structural injury to the vasculature after ischemic injury in superoxide ...

The TRAM-flap has become a well-established method for breast reconstruction. Even though the aesthetic result is superior to implant reconstruction, a main disadvantage is the potential risk to create weakness of the abdominal wall. For evaluation of abdominal wall function, an imaging method has to be used which is able to prove ...

The incidence of bilateral breast reconstruction is increasing particularly due to genetic counseling and the option for bilateral prophylactic mastectomies. The decision to undergo a prophylactic mastectomy depends on the achievable outcomes of breast reconstruction. The free superior gluteal artery perforator flap (sGAP) flap is one option for autologous ...

This study examines the vascular anatomy of the TRAM flap and evaluates risk factors associated with complications among 556 women who had TRAM flap breast reconstruction. Fifty-nine patients (10.6 percent) developed fat necrosis involving 10 percent or more of their breast. Risk factors associated with fat necrosis were a history of chest-wall irradiation ...

BACKGROUND: Breast reconstruction with autogenous tissue is a well-established technique, but there are some limitations related to donor-site morbidity. Among available techniques, the superficial inferior epigastric artery (SIEA) flap is the least invasive procedure because it does not require harvesting or incision of the rectus muscle or the abdominal ...

Background: Three-dimensional computed tomographic angiography (3D CTA) can be used preoperatively to evaluate the course and caliber of perforating blood vessels for abdominal free-flap breast reconstruction. For postmastectomy breast reconstruction, many women inquire whether the abdominal tissue volume will match that of the breast ...

Complex ventral hernias represent a significant challenge to surgeons. We hypothesized that a wide underlay technique in combination with a novel biologic mesh would result in repair with a low recurrence rate. Medical records of patients undergoing ventral herniorrhaphy with XenMatrix biologic mesh were evaluated. All patients were evaluated for hernia recurrence both immediately and after 2 to 3 ...

The reasons for transcranial operative revision of anterior cranial fossa are cerebrospinal fluid (CSF) leakage, pneumocephalus, recurrent meningitis and eventually other causes. The trauma is the most common etiology of previously mentioned pathologic statuses, rarely it can also be long-lasting intracranial hypertension. We retrospectively analyzed our 61 patients, operatively treated at ...

Although most wound complications after renal transplantation are minor, the renal allograft, in its superficial and extraperitoneal location, is vulnerable to exposure if there is wound breakdown resulting in loss of overlying tissue. We describe a 66-year-old man who received a renal allograft from a deceased donor for end-stage renal disease (ESRD) secondary to polycystic kidney disease.His ...

In the last 25 years increased popularity of damage control surgery and recognition of abdominal compartment syndrome has lead to a raised incidence of open abdomens. Even though these procedures are often life-saving, morbidity and mortality associated with an open abdomen remains high. Third spacing after aggressive fluid resuscitation, fascial ...

IntroductionHepatic hydatid disease can be successfully treated by a variety of modalities.Case PresentationWe report a case of a 60 year old male with giant hepatic hydatid disease who presented with a huge cystic mass in the upper abdomen. Diagnosis was confirmed by serology, ultrasonography and CT scan. The patient was treated successfully by open minimally invasive surgery with minimum ...

This study compared the deep inferior epigastric perforator (DIEP) flap and the free transverse rectus abdominis myocutaneous (TRAM) flap in postmastectomy reconstruction using a cost-effectiveness analysis. A decision analytic model was used. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of ...

Subluxation and dislocation of the temporomandibular joint (TMJ) are very unpleasant and distressing conditions to patients; they are not common diseases, but large groups of people in countries such as Yemen and Somalia are affected owing to daily chewing of Qat for several hours every day, but in Iraq, the conditions are not common. These clinical studies were conducted on 133 patients: 87 men ...

This article presents a new repositioning method in dystopic microtia (low-set microtia, anteriorly tilted microtia, or both) with the presence of the external auditory canal. In the case of low-set malformations, the dystopic auricular canal complex was freed from adjacent bony structure, shifted upward, and anchored to the thick periosteum of the suprameatal triangle or the adjacent superior ...

Experience with 600 operations, including 200 second-look operations, for the management of lipodystrophy, fatty excess and other unsightly affections of the abdominal wall allows defining a few essential elements. The routine procedure consists in lowering the supraumbilical curtain down to the pubis after transposition of the umbilicus. This is indicated in case of ...

A description of two cases of internal herniation caused by a defect in the closure of the peritoneal flap during a trans-abdominal pre-peritoneal procedure is presented here. They were both successfully treated laparoscopically. This rare condition should be considered when patients who have had recent trans-abdominal surgery for ...

The application of composite tissue allograft (CTA) transplants in clinical reconstruction is parallel with extended knowledge of anatomy, microsurgical skills and development of transplantation immunology. CTAs are composed of multiple tissues, some of which such as skin are highly immunogenic and cause strong immunologic responses. Strong antigenic nature of skin may be related to Langerhans ...

Trocar injury is one of the most serious and potentially preventable complications of laparoscopic surgery. Use of a blunt rather than a cutting trocar could be expected to lessen the likelihood of this injury. Therefore complications related to laparoscopic port design were studied by comparing conventional cutting trocars with radially expanding (blunt) trocars. A multicenter, prospective, ...

Background/Aims: An omental flap covering the splanchnic vessels might reduce postoperative intra-abdominal hemorrhage after pancreaticoduodenectomy. However, the efficiency of such a procedure remains to be verified. The purpose of this study was to determine the effect of omental flap placement in pancreaticoduodenectomy on the ...

The authors present a single center's experience in bilateral breast reconstruction using perforator free flaps. The aim of this study was to show their indications, surgical technique, and results. A series of 53 patients underwent this procedure between February of 1996 and October of 2002. The surgical procedures were performed on patients with bilateral breast cancer (11 ...

Objective: Temporalis musculofascial rotational flaps can provide excellent tissue for reconstruction of defects in the floor of the middle cranial fossa. This technique can, however, result in cosmetic deformity of the temporal fossa with an asymmetric contour of the head. We report a technique that uses titanium mesh and autologous abdominal adipose to ...

Proanthocyanidins are potent natural antioxidants which belong to a class of polyphenols. Proanthocyanidin-rich extracts are prepared from grape seeds. The effect of grape seed proanthocyanidin extract (GSPE) on the viability of abdominal skin flaps exposed to warm ischaemia and subsequent reperfusion were studied in 40 male Wistar rats. In the control ...

INTRODUCTION: The anterolateral abdominal wall is innervated by the T7 to L1 anterior rami, whose nerves travel in the fascial plane between the internal oblique and transversus abdominus muscles, known as the transversus abdominus plane (TAP). Ultrasound-guided techniques of regional anesthesia that target the TAP are increasingly relied upon by ...

The symmetry of, and physical characteristics influencing, the thickness of the lateral abdominal muscles at rest and during abdominal exercises were examined in 57 healthy subjects (20 men, 37 women; aged 22�62 years). M-mode ultrasound images were recorded from the abdominal muscles at rest and during abdominal ...

An accurate preoperative evaluation of the vascular anatomy of the abdominal wall is essential in deep inferior epigastric perforator (DIEP) flap reconstruction. We present our experience of using computed tomographic angiography (CTA) of the abdomen as part of our standard preoperative assessment of abdominal-based breast ...

SUMMARYDesmoid tumor is a rare, benign fibroblastic tumor that is characterized by highly aggressive local invasiveness.The authors report the case of a 35 year old male who presented with a 20 cm para-umbilical tumor invading the right rectus abdominis muscle. This required a wide excision of the abdominal wall. The resulting defect was closed with a single-stage latissimus ...

Objective: Providing adequate soft tissue cover while preventing wound breakdown and infection can present a challenge when repairing large meningomyeloceles. Adding an extra barrier to protect the underlying dural elements in the event of complications should lower the morbidity and mortality associated with large repairs, which are at risk of dehiscence and subsequent exposure of the neural ...

Necrotising fasciitis of the external genitalia following routine circumcision is uncommon. We describe reconstruction of the scrotum with local perforator flaps and a dermal regeneration template (Integra) to cover the penile shaft after debridement. Lotus petal flaps were originally designed to cover vulvo-vaginal defects, but in this instance integrated ...

Introduction:Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), posttraumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions.Case Report:We present 2 patients ...

Hernia repair continues to be a problem facing surgeons today, particularly because of the high incidence of reoccurrence. This work presents preliminary data of a pioneering effort to investigate the effect of mesenchymal stromal cells (MSCs) on mechanical property enhancement in full thickness fascial defects. Heparinized MSCs harvested from a rabbit's tibia/iliac crest were ...

Reconstruction of large, infected abdominal wall defects is often difficult. Local factors, such as defect size, presence of infection, adequate skin coverage and presence of enteric fistulae dictate the reconstructive method that can be used. Placement of prosthetic mesh materials into infected defects was generally not recommended due to a high rate of extrusion and ...

This paper describes previously unreported, acute inguinal herniation during high +Gz air combat maneuvers. The flight surgeon aircrew member involved incorrectly analyzed the etiology of the abdominal wall discomfort during and immediately after the mission. Several factors contributed to the delayed diagnosis. Surgical exploration and repair revealed larger than expected ...

Breast cancer is a common cancer among women. The transverse rectus abdominis myocutaneous (TRAM) flap is a popular option because not only does it provide a breast with satisfactory bulk composed of autogenous tissue but it also provides an abdominal dermolipectomy to the patient. Fat necrosis remains a common problem following TRAM ...

This report presents an extended groin flap design that consists of a conventional skin paddle in the groin region and a vertical extension in the anteromedial thigh region, based on the superficial iliac circumflex artery and an unnamed descending branch, respectively. The inferior branch of the superficial iliac circumflex artery that supplies the thigh extension of the ...

OBJECTIVES: Sufficient closure of intraoral defects can be challenging. Various methods of tissue transfer have been presented in the literature. From skin grafts to microvascular flaps, most techniques used for intraoral reconstruction use skin to line out the oral cavity to guarantee an epithelial surface. Native mucosa tolerates the moist environment of the oral cavity, ...

Deep burns of the perineum result in perineal obliteration, hip adduction contracture, and limitation of hip range of motion. Bodily hygiene becomes difficult to maintain. Perineal obliteration is often combined with inguinal and perianal contractures and genitalia injury. These factors present a challenge for the surgeon. The extreme scar surface deficit and the fold absence in the perineal ...

Preoperative selective embolization of the deep inferior epigastric arteries constitutes a new technique in TRAM flap delay. Whereas surgical ligation of these vessels has proved to be an effective delay procedure in experimental and clinical settings, it requires an additional operative step under general anesthesia. Despite the introduction of the free TRAM leading to ...

Presented is a new technique in preoperative conditioning of the pedicled TRAM-flap employing an interventional-radiologic procedure, selective embolization of the deep inferior epigastric artery (DIEA). During a four year period in 40 patients with a mean age of 48.4 (31-66) years breast reconstruction was performed by a superiorly pedicled TRAM-flap ...

The tumescent technique has been shown to be efficacious in reducing both operative and postoperative bleeding without significant deleterious side effects in suction lipectomy. In this study, the effects of the tumescent technique on postoperative complications in transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction are investigated. All women who ...

OBJECTIVE: Patients with and without radiation treatment before their breast reconstruction were compared to study the relationship of radiation to flap-related complications. SUMMARY BACKGROUND DATA: The transverse rectus abdominis muscle (TRAM) flap for breast reconstruction involves a a vascular pedicle and recipient bed, both included in the radiated ...

The primary question addressed was whether muscle flaps (MFs) offer a significant advantage over an omental flap (OF) in the management of deep sternal wound infection (DSWI) following cardiovascular surgery in terms of outcome (morbidity and mortality). Altogether, 333 citations (from PubMed and EMBASE and using a manual search, without language ...

Use of the deep inferior epigastric perforator (DIEP) flap is gaining popularity as the method of choice for breast reconstruction and replacement of prosthetic breast implants. Ideally, the volume of the prosthesis is replaced by the same volume of autologous tissue to restore shape and symmetry. Still, intraoperative tissue volumetry is not practical under sterile ...

Ventral hernia formation is a common complication of rectus abdominis musculocutaneous flap harvest. The site and extent of harvest of the flap are known contributing factors. Therefore, an accurate location of the arcuate line of Douglas, which marks the lower extent of the posterior wall of the rectus sheath, may be relevant before harvesting the ...

PURPOSE: Total or subtotal glossectomy following the resection of intraoral tumors causes significant morbidity. However, which reconstructive technique is the most successful remains controversial. PATIENTS AND METHODS: After approval by the Ethics Committee, charts were reviewed retrospectively for patients treated at the Oral and Maxillofacial Surgery Department, University Hospital La Paz ...

In rectus abdominis myocutaneous island flaps (3.0 x 1.5 cm) of 86 rats (Uje: WIST) transcutaneous oxygen tension measurements (tcPO2) were made by a Universal-PO2-Meter MO 10.1 (PRACITRONIC, Dresden, GDR) for monitoring flap viability following blood flow insufficiency produced experimentally. This insufficiency was induced by ligation of the pedicle ...

The abdominal wall function of 57 patients who have undergone TRAM flap breast reconstructions using the whole rectus muscle, on one side (33 patients) or both (24 patients), was evaluated 6 months to 2 years after surgery. The defect was repaired with a Teflon mesh buried in the rectus sheath. There was a perfect tolerance to the mesh, and no hernia or ...

The use of biomaterials for the repair of abdominal wall defect is becoming common and safe. It has been 20 years since the senior author developed a method to reconstruct the very large transfixing abdominal wall defect with a combination of two biomaterials (Gore Tex) PTFE as a neo peritoneum and polypropylene superficial to this in order to give ...

IntroductionDesmoid tumors are benign but locally aggressive tumors of mesenchymal origin which are poorly circumscribed, infiltrate the surrounding tissue, lack a true capsule and are composed of abundant collagen. History of trauma to the site of tumor origin is elicited in up to 1 in 4 cases and they most commonly develop in the anterior abdominal wall and shoulder girdle ...

The incidence of postoperative abdominal bulge, hernia, and the ability to do sit-ups was reviewed in a series of 268 patients who had undergone free TRAM (FTRAM) or conventional TRAM (CTRAM) flap breast reconstruction. Minimum follow-up was 6 months. Patients were divided into four groups: unilateral FTRAM (FT1P; n = 123), double-pedicle bilateral FTRAM ...

The purpose of this study was to report the operative findings in patients who underwent a secondary operation for cubital tunnel syndrome. A chart review was performed of 100 patients who had undergone a secondary operation for cubital tunnel syndrome by one surgeon. The mean age was 48�years (standard deviation 13.5�years). The most common complaint after primary surgery was increased ...

We designed a multicenter study to compare tobramycin/clindamycin to imipenem/cilastatin for intra-abdominal infections. We included the Acute Physiology and Chronic Health Evaluation (APACHE II) index of severity and excluded patients without established infection. Two hundred ninety patients were enrolled, of whom 162 were evaluable. Using logistic regression to analyze both ...

The unipedicled TRAM flap is an useful alternative to breast reconstruction after mastectomy in patients who refuse mammary implants. There is however the risk of unpredictable partial skin necrosis even after rigorous surgical procedures. Certain authors have proposed color flow doppler assessment before reconstructive surgery better to identify the vascular network and ...

We present herein a case of massive arterial thrombosis of a free rectus abdominal musculocutaneous flap used for reconstructive surgery of gingival carcinoma that could not be rescued. A 54-year-old woman underwent the operation. She had experienced two miscarriages in her 20s, but medical history was otherwise uneventful. Intraoperatively, the ...

Prelamination is sometimes required for reconstruction of specialized organs. The purpose of this study was to create a chimeric flap model in dogs for prelamination. The anatomy of the deep and superficial caudal epigastric vessels, which supply the rectus abdominis muscle and superficial ventral fascia, respectively, were measured in 14 dogs. Their lengths were ~30 mm with ...

Background: Traditionally, repair of the midline fascial defect has been performed with interrupted or running permanent sutures during abdominoplasty. Barbed suture devices, however, eliminate the need for knot tying and potentially are equally effective at maintaining the repair while allowing for faster deployment and elimination of a potential nidus for infection. ...

Bedside laparotomy (BSL) was introduced as a heroic procedure in trauma patients too unstable for safe transport to the operating room (OR). We hypothesize a BSL protocol would maintain patient safety while reducing OR use. Patients were prospectively entered into a BSL protocol from July 2002 to June 2003 and retrospectively reviewed. Protocol indications for BSL were ...

Bilateral prophylactic mastectomy can reduce the incidence of breast cancer by 87 to 93% in high-risk individuals and is an appealing option for many patients if reconstruction can be provided with acceptable morbidity and outstanding esthetic results. Autogenous breast reconstruction techniques have evolved over the last 20 years to meet this goal. Familiarity with the deep inferior epigastric ...

Spine stabilization exercises, in which patients are taught to perform isolated contractions of the transverses abdominus (TrA) during �abdominal hollowing�, are a popular physiotherapeutic treatment for low back pain (LBP). Successful performance is typically judged by the relative increase in TrA thickness compared with that of the internal (OI) and external (OE) oblique ...