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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

Schema of the abdominal wall. (A) The normal abdominal wall. (B) Left: postoperative conditions after bilateral TRAM-flap. Right: abdominal bulge that developed in the present case. (C) Conditions after abdominal wall component separation, before double-layer midline closure. (D) Postoperative conditions after mesh augmentation.
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Figure 3: Schema of the abdominal wall. (A) The normal abdominal wall. (B) Left: postoperative conditions after bilateral TRAM-flap. Right: abdominal bulge that developed in the present case. (C) Conditions after abdominal wall component separation, before double-layer midline closure. (D) Postoperative conditions after mesh augmentation.

Mentions: In the case described in this report the bilateral non-muscle-sparing TRAM-flap transfer led to an enormous abdominal bulge that caused disability for the patient in many different ways. To date, no standard surgical procedure has been developed to treat these defects. Damage to the TRAM-flap resulted in a broad defect in the area of the harvested rectus muscle that could not be reversed (Figure 3). The principal idea of any repair should be to reconstruct the abdominal wall integrity with closure of the fascial defect. In 1990, Ramirez et al [7] described a component separation technique which allowed a midline advancement of the abdominal wall of up to 10 cm on each side, without the need for musculofascial flaps. Moreover, this technique provides an innervated and vascularized compound for dynamic support by dividing the abdominal wall components along an avascular plane.


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)

Schema of the abdominal wall. (A) The normal abdominal wall. (B) Left: postoperative conditions after bilateral TRAM-flap. Right: abdominal bulge that developed in the present case. (C) Conditions after abdominal wall component separation, before double-layer midline closure. (D) Postoperative conditions after mesh augmentation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Schema of the abdominal wall. (A) The normal abdominal wall. (B) Left: postoperative conditions after bilateral TRAM-flap. Right: abdominal bulge that developed in the present case. (C) Conditions after abdominal wall component separation, before double-layer midline closure. (D) Postoperative conditions after mesh augmentation.
Mentions: In the case described in this report the bilateral non-muscle-sparing TRAM-flap transfer led to an enormous abdominal bulge that caused disability for the patient in many different ways. To date, no standard surgical procedure has been developed to treat these defects. Damage to the TRAM-flap resulted in a broad defect in the area of the harvested rectus muscle that could not be reversed (Figure 3). The principal idea of any repair should be to reconstruct the abdominal wall integrity with closure of the fascial defect. In 1990, Ramirez et al [7] described a component separation technique which allowed a midline advancement of the abdominal wall of up to 10 cm on each side, without the need for musculofascial flaps. Moreover, this technique provides an innervated and vascularized compound for dynamic support by dividing the abdominal wall components along an avascular plane.

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