• Archives of Reconstructive Microsurgery
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• v.4 no.1
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• pp.23-32
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• 1995

Severe upper and lower extremity trauma may result in soft tissue loss with exposed bone and the subsequence of risk of chronic osteomyelitis or malunion of fracture fragments. Such injuries present a major reconstructive problem. But Since the introduction of microsugical technique, free muscle and myocutaneous flaps were employed to provide coverage of severely injured defects. Since Tai and Hasegawa(1974) first reported a breast reconstruction using by rectus abdominis myocuraneous flap, the free rectus myocutaneous flap has been widely employed for breast reconstuction, head and neck reconstruction, and extremity reconstruction in these days. The authors present their successful experience with free rectus abdominis muscle and rectus abdominis myocutaneous flaps for upper and low extremity reconstruction. From Nov. 94, to May 95, Five cases of severely injured extremites due to trauma or contact burn were treated with free rectus abdominis muscle flap or free rectus abdominis myocutaneous flap. All flaps except 1 case were survived without severe complications. As free muscle or myocutaneous flap, the free rectus abdominis flap has the advantages of a reliable pedicle, easy dissection, and an acceptable donor site, so it seems logical to apply the free rectus abdominis flap to apply in upper and lower extremity reconstruction.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.80-91
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• 1996

A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

• Archives of Reconstructive Microsurgery
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• v.5 no.1
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• pp.92-98
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• 1996

The rectus abdominis myocutaneous flap is frequently used in the field of plastic and reconstructive surgery such as breast reconstruction and as a donor of free tissue transfer. Major problems with this flap is bulkiness, the possibility of postoperative abdominal herniation and muscle weakness following the removal of the rectus abdominis muscle. We used paraumbilical perforator based skin flap fed by a muscle perforator from the deep inferior epigastric artery, with no or little muscle and fatty tissue, in three patients for the resurfacing of relatively wide and thin defects. This technique has all of the advantages of the conventional rectus abdominis myocutaneous flap with decreased possibility of postoperative abdominal herniation or muscle weakness. Another challenging merit is possibility of skin flap thinning.

• Journal of Yeungnam Medical Science
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• v.28 no.2
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• pp.116-123
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• 2011

The incidence of breast cancer, the second most prevalent cancer type in South Korea, has increased by 6.8% annually in the last six years. The higher number of breast cancer patients has led to an increase in the cases of skin-sparing mastectomies, thereby increasing the need for reconstructive procedures. The reconstruction options include alloplastic techniques such as implant or autologous reconstruction with numerous flaps. The abdominal area is the preferred donor site for the harvest of autologous tissue for breast reconstruction. Breast reconstruction using abdonimal tissue is commonly accomplished using the transverse rectus abdominis myocutaneous (TRAM) flap. The establishment of microvascular surgery led to the development of the free TRAM flap because of its increased vascularity and decreased rectus abdominis sacrifice. The muscle-sparing TRAM, DIEP, and SIEA flap techniques were later developed in an effort to decrease the abdominal-donar-site morbidity by decreasing the injury to the rectus abdominis muscle and fascia. This article summarizes the various abdominal flaps for breast reconstruction.

• Archives of Reconstructive Microsurgery
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• v.17 no.2
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• pp.94-100
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• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.

• Archives of Reconstructive Microsurgery
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• v.23 no.1
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• pp.18-20
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• 2014

Two aged patients who had open tibial fractures with arterial injury caused by high energy accidents underwent emergency arterial reconstruction using a greater saphenous vein and soft tissue repair using free flaps. In the patients, soft tissue necrosis developed and tibias were exposed at postoperative third week. Follow-up angiography through the superficial femoral artery showed occlusion of the anterior tibial artery. The anterior tibial artery was reconstructed using the contralateral greater saphenous vein graft and the latissimus dorsi myocutaneous and rectus abdominis muscle free flaps were transplanted for repair of necrotic soft tissue. The reconstructed arteries showed good perfusion to the new free flaps until union of the tibias occurred. The patients were followed-up for 21 years and 17 years postoperatively, respectively. In management of open comminuted fracture of the tibia, injury of the arterial system must be ruled out by angiography in addition to evaluation of the degree of soft tissue injury.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.88-91
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• 2020

Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignancy. This report describes the case of an unusual extensive SCC involving the whole hemiface, which required reconstruction with a combination of a dual vascular free transverse rectus abdominis muscle (TRAM) flap and a skin graft. A 79-year-old woman visited our hospital with multiple large ulcerated erythematous patches on her right hemiface, including the parieto-temporal scalp, bulbar and palpebral conjunctiva, cheek, and lip. A preliminary multifocal biopsy was performed in order to determine the resection margin, and the lesion was resected en bloc. Orbital exenteration was also performed. A free TRAM flap was harvested with preserved bilateral pedicles and was anastomosed with a single superior thyroidal vessel. The entire TRAM flap survived. The final pathological examination of the resected specimen confirmed that there was no regional nodal metastasis, perineural invasion, or lymphovascular involvement. The patient was observed for 6 months, and there was no evidence of local recurrence. Usage of a TRAM flap is appropriate for hemifacial reconstruction because the skin of the abdomen matches the color and pliability of the face. Furthermore, we found that the independent attachment of two extra-flap anastomoses to a single recipient vessel can safely result in survival of the flap.

• Archives of Plastic Surgery
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• v.46 no.2
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• pp.140-146
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• 2019

Background Thoracodorsal vessels (TDVs) and internal mammary vessels (IMVs) have both been widely employed as recipient vessels for use in free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps. However, whether TDVs or IMVs are preferable as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap remains controversial. The purpose of this study was to compare the clinical outcomes when TDVs were used as recipient vessels to those obtained when IMVs were used as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap. Methods A retrospective matched-cohort study was performed. We retrospectively reviewed data collected from patients who underwent a free MS-TRAM flap for autologous breast reconstructions after mastectomy between March 2003 and June 2013. After a one-to-one matching using age, 100 autologous breast reconstructions were selected in this study. Of the 100 breast reconstructions, 50 flaps were anastomosed to TDVs and 50 to IMVs. Patient demographics and clinical outcomes including operation time, length of hospital stay, postoperative complications, and aesthetic score were compared between the two groups. Results No statistically significant differences were found between the two groups in patient demographics and clinical outcomes, including the complication rates and aesthetic scores. There were no major complications such as total or partial flap loss in either group. Conclusions The results of our study demonstrate that both TDVs and IMVs were safe and efficient as recipient vessels in terms of the complication rates and aesthetic outcomes.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.3-10
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• 2012

The free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) and deep inferior epigastric perforator (DIEP) flaps involve transferring skin and subcutaneous tissue from the lower abdominal area and have many features that make them well suited for breast reconstruction. The robust blood supply of the free flap reduces the risk of fat necrosis and also enables aggressive shaping of the flap for breast reconstruction to optimize the aesthetic outcome. In addition, the free MS-TRAM flap and DIEP flap require minimal donor-site sacrifice in most cases. With proper patient selection and safe surgical technique, the free MS-TRAM flap and DIEP flap can transfer the lower abdominal skin and subcutaneous tissue to provide an aesthetically pleasing breast reconstruction with minimal donor-site morbidity.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.129-134
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• 1998

The ability for tissue transfer based on microvascular anastomosis has created a revolution in microsurgical free tissue transplantation. The advantages of cutaneous flaps are that they are soft, durable and provide a good cosmetic reconstruction and muscle flaps have a more vigorous blood supply and a longer, larger vascular pedicle than cutaneous flaps. From June 1992 through May 1997, 68 patients had received reconstructive microsurgery in the lower extremity at Department of Orthopedic Surgery, Chonbuk National University Hospital. The results were as follows. 1. The age distribution was from 15 years of age to 67 and male were 59 cases and female 9 cases. 2. The most common cause was traffic accident(54 cases, 79.4%) and followed chronic osteomyelitis(9 cases, 13.2%), industrial accident(3 cases, 4.4%), burn(1 case, 1.5%) and farm injury(1 case, 1.5%). 3. Latissimus dorsi myocutaneous flap were 25 cases(36.8%), rectus abdominis muscle flap 21 cases(30.9%), gracilis muscle flap 10 cases(14.7%), dorsalis pedis flap 9 cases(13.2%), groin 2(2.9%) and vascularized iliac osteocutaneous flap 1(1.5%). 4. 61 cases(89.7%) of 68 cases were survived and the exposed vital tissues and bones were covered and revealed good cosmetic results.