Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지

Usefulness of Muscle Plication and Synthetic Mesh in Breast Reconstruction Using TRAM Pedicled Flap

배곧은근피판을 이용한 유방재건 시 복벽의 주름형성과 합성그물을 이용한 복부성형술의 유용성

  • Park, Jung Min (Department of Plastic and Reconstructive Surgery(Breast Center), College of Medicine, Dong-A University) ;
  • Park, Su Seong (Department of Plastic and Reconstructive Surgery(Breast Center), College of Medicine, Dong-A University) ;
  • Lee, Keun Cheol (Department of Plastic and Reconstructive Surgery(Breast Center), College of Medicine, Dong-A University) ;
  • Kim, Seok Kwun (Department of Plastic and Reconstructive Surgery(Breast Center), College of Medicine, Dong-A University) ;
  • Cho, Se Hyun (Department of Surgery(Breast Center), College of Medicine, Dong-A University)
  • 박정민 (동아대학교 의과대학 성형외과학교실(유방센터)) ;
  • 박수성 (동아대학교 의과대학 성형외과학교실(유방센터)) ;
  • 이근철 (동아대학교 의과대학 성형외과학교실(유방센터)) ;
  • 김석권 (동아대학교 의과대학 성형외과학교실(유방센터)) ;
  • 조세헌 (동아대학교 의과대학 외과학교실(유방센터))
  • Received : 2006.03.08
  • Published : 2006.09.10
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The transverse rectus abdominis myocutaneous(TRAM) flap has become a mainstay of breast reconstruction. The chief disadvantage of the TRAM flap is its potential to create a weakness in the abdominal wall. Nowadays true hernia is less frequent, but bulging that appears at the muscle donor site, or at the contralateral side, or at the epigastric area is still remained as a problem. To prevent this complications, we have used synthetic mesh as well as abdominal muscle plication. Now we report the result of our methods. Methods: We started to use synthetic mesh and muscle plication as supplementary reinforcement for entire abdominal wall, after TRAM flap harvesting, in an attempt to stabilize it and achieve a superior aesthetic result since 2002. We observed complications of TRAM flap donor site, and compared our results (from January, 2002 to January, 2006) with other operator's result (before 2001) at the same hospital in aspect of incidence of abdominal complications. Results: 42 consecutive patients have been performed routine reinforcement with the extended mesh technique and muscle plication from January, 2002 to January, 2006. Mean patient follow up was 25.2 months. No hernia or mesh related infection were encountered and only one patient had a mild abdominal bulging. Nevertheless the our good results, there were no significant statistical differences were observed between two groups. Conclusion: We recommend the using of synthetic mesh and muscle plication for donor site reconstruction after TRAM flap breast reconstruction to improve strength as well as aesthetic quality of the abdominal wall.

Keywords

Acknowledgement

Supported by : 동아대학교

References

  1. Kroll SS, Marchi M: Comparison of strategies for preventing abdominal wall weakness after TRAM flap breast reconstruction. Plast Reconstr Surg 89: 1045, 1992
  2. Hartrampf CR Jr: The transverse abdominal island flap for breast reconstruction: a 7-year experience. Clin Plast Surg 15: 703, 1988
  3. Nahai F: Comparison of strategies for preventing abdominal wall weakness after TRAM flap breast reconstruction (Discussion). Plast Reconstr Surg 89: 1052, 1992
  4. Yoon JS, Lee HB, Lee SH, Shin KS: Functional & anatomic reconstruction of the donor site after the transverse rectus abdominis myocutaneous(TRAM) flap transfer. J Korean Soc Plast Reconstr Surg 19: 459, 1992
  5. Amid PK: Oassification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia 1: 15, 1997
  6. Moscona RA, Ramon Y, Toledano H, Barzilay G: Use of synthetic mesh for the entire abdominal wall after TRAM flap transfer. Plast Reconstr Surg 101: 706, 1998
  7. Hudson DA: A paradigm shift for plastic surgeons: no longer focusing on excising skin excess. Plast Reconstr Surg 106: 497, 2000
  8. Park JM, Ha SU, Lee KC, Kim SK, Son CH: The effect on pulmonary function after abdominoplasty. J Korean Soc Plast Reconstr Surg 32: 733, 2005
  9. Nahas FX, Augusto SM, Ghelfond C: Should diastasis recti be corrected? Aesthetic Plast Surg 21: 285, 1997
  10. Van Uchelen JH, Kon M, Werker PM: The longterm durability of placation of the anterior rectus sheath assessed by ultrasonography. Plast Reconstr Surg 107: 1578, 2001