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New technical approach for the repair of an abdominal wall defect after a transverse rectus abdominis myocutaneous flap: a case report.

Kaemmer DA, Conze J, Otto J, Schumpelick V - J Med Case Rep (2008)

Bottom Line: In the absence of rectus muscle, the large defect was repaired using a combination of the abdominal wall component separation technique of Ramirez et al and additional mesh augmentation with a lightweight, large-pore polypropylene mesh (Ultrapro).The procedure of Ramirez et al is helpful in achieving a tension-free closure of large defects in the anterior abdominal wall.The additional mesh augmentation allows reinforcement of the thinned lateral abdominal wall.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Medical Faculty, Rheinish-Westphalian Technical University, Aachen, Germany. dkaemmer@ukaachen.de

ABSTRACT

Introduction: Breast 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 presentation: We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap (TRAM-flap) breast reconstruction. The surgery led to the patient developing an enormous abdominal bulge that caused her disability in terms of abdominal wall and bowel function, pain and contour. In the absence of rectus muscle, the large defect was repaired using a combination of the abdominal wall component separation technique of Ramirez et al and additional mesh augmentation with a lightweight, large-pore polypropylene mesh (Ultrapro).

Conclusion: The procedure of Ramirez et al is helpful in achieving a tension-free closure of large defects in the anterior abdominal wall. The additional mesh augmentation allows reinforcement of the thinned lateral abdominal wall.

No MeSH data available.


Related in: MedlinePlus

Abdominal contour before and after reconstruction. (A) The preoperative abdominal contour (lateral view). (B) The abdominal contour six weeks after the reconstruction (lateral view). In addition to minimizing the abdominal bulge, Ramirez et al's technique is able to shape the lateral abdominal wall in an aesthetic manner; lateral bulging was avoided using mesh augmentation.
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Figure 1: Abdominal contour before and after reconstruction. (A) The preoperative abdominal contour (lateral view). (B) The abdominal contour six weeks after the reconstruction (lateral view). In addition to minimizing the abdominal bulge, Ramirez et al's technique is able to shape the lateral abdominal wall in an aesthetic manner; lateral bulging was avoided using mesh augmentation.

Mentions: The patient presented at the authors' outpatient clinic eight months after reconstruction. At that time her body mass index was 18.9 and she was suffering from a lower abdominal bulge formation (Figure 1). An ultrasound examination revealed an abdominal wall defect measuring 18 × 20 cm, with no detectable rectus abdominis muscle remaining, resembling a large rectus diastasis. A preoperative endoscopy of the colon showed signs of adhesions in the colon sigmoideum and transversum, but no other pathologies; the laboratory values were normal. Apart from an appendectomy performed 20 years ago, the patient had undergone no other previous abdominal surgery. In addition to the annoying large bulge in this otherwise slim patient, the pain experienced during everyday movement and impairment of bowel function led to an explorative laparotomy and an attempt to reconstruct the abdominal wall.


New technical approach for the repair of an abdominal wall defect after a transverse rectus abdominis myocutaneous flap: a case report.

Kaemmer DA, Conze J, Otto J, Schumpelick V - J Med Case Rep (2008)

Abdominal contour before and after reconstruction. (A) The preoperative abdominal contour (lateral view). (B) The abdominal contour six weeks after the reconstruction (lateral view). In addition to minimizing the abdominal bulge, Ramirez et al's technique is able to shape the lateral abdominal wall in an aesthetic manner; lateral bulging was avoided using mesh augmentation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2365962&req=5

Figure 1: Abdominal contour before and after reconstruction. (A) The preoperative abdominal contour (lateral view). (B) The abdominal contour six weeks after the reconstruction (lateral view). In addition to minimizing the abdominal bulge, Ramirez et al's technique is able to shape the lateral abdominal wall in an aesthetic manner; lateral bulging was avoided using mesh augmentation.
Mentions: The patient presented at the authors' outpatient clinic eight months after reconstruction. At that time her body mass index was 18.9 and she was suffering from a lower abdominal bulge formation (Figure 1). An ultrasound examination revealed an abdominal wall defect measuring 18 × 20 cm, with no detectable rectus abdominis muscle remaining, resembling a large rectus diastasis. A preoperative endoscopy of the colon showed signs of adhesions in the colon sigmoideum and transversum, but no other pathologies; the laboratory values were normal. Apart from an appendectomy performed 20 years ago, the patient had undergone no other previous abdominal surgery. In addition to the annoying large bulge in this otherwise slim patient, the pain experienced during everyday movement and impairment of bowel function led to an explorative laparotomy and an attempt to reconstruct the abdominal wall.

Bottom Line: In the absence of rectus muscle, the large defect was repaired using a combination of the abdominal wall component separation technique of Ramirez et al and additional mesh augmentation with a lightweight, large-pore polypropylene mesh (Ultrapro).The procedure of Ramirez et al is helpful in achieving a tension-free closure of large defects in the anterior abdominal wall.The additional mesh augmentation allows reinforcement of the thinned lateral abdominal wall.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Medical Faculty, Rheinish-Westphalian Technical University, Aachen, Germany. dkaemmer@ukaachen.de

ABSTRACT

Introduction: Breast 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 presentation: We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap (TRAM-flap) breast reconstruction. The surgery led to the patient developing an enormous abdominal bulge that caused her disability in terms of abdominal wall and bowel function, pain and contour. In the absence of rectus muscle, the large defect was repaired using a combination of the abdominal wall component separation technique of Ramirez et al and additional mesh augmentation with a lightweight, large-pore polypropylene mesh (Ultrapro).

Conclusion: The procedure of Ramirez et al is helpful in achieving a tension-free closure of large defects in the anterior abdominal wall. The additional mesh augmentation allows reinforcement of the thinned lateral abdominal wall.

No MeSH data available.


Related in: MedlinePlus