Coverage of large soft tissue defects at the hip region constitutes a challenge for plastic surgeons. Transverse rectus abdominus myocutaneous flap definition. Intercostal arterybased rectus abdominis transposition. The compound flap of the rectus muscle, with its attached internal obliquetransversus abdominis muscle, can be advanced 10 cm around the waistline.
The outer, most lateral line, defining the abs is the. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and. Breast reconstruction with transverse rectus abdominis. Whiletryingtobracethetorso,an athlete with an overdeveloped rectus abdominis will produce trunk. Overtraining the rectus abdominis can make you less. We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap tram flap breast reconstruction. The rectus abdominis flap is favored for this application because of its ease of harvest and reliability. The myofascial pain pattern has pain locations that are displayed in red and associated trigger points shown as xs. It can be harvested as a muscleonly flap or as a myocutaneous flap. First described by mathes and bostwick in 1977, 3 the rectus abdominis myocutaneous ram flap has been used in the reconstruction of surgical defects at various sites of the body.
The number of reports on its applications in the head and neck is limited. We performed peritoneal reconstruction by free fascia lata transplantation and abdominal wall reconstruction with an extended trilobed rectus abdominis musculocutaneous flap. The anterior and posterior rectus sheaths merge in the midline to form the linea alba that separates the paired rectus muscles. The myocutaneous flap of the rectus abdominis is based on utilisation. Modified vertical rectus abdominis musculocutaneous flap. In 25 cadavers the width and length of the portions of rectus and transversus abdominis muscles suitable for the tramp flap as well as the length and diameter of the inferior epigastric artery were. Pdf new technical approach for the repair of an abdominal wall. Rectus abdominis muscle an overview sciencedirect topics. Expose the layers of abdominal wall reconstruction aapc.
Learn rectus abdominis with free interactive flashcards. Rectus abdominis musculocutaneous flap incision academy. Transverse rectus abdominus myocutaneous flap definition of. The ease of dissection, coupled with the large calibre and length of the vascular stem, are key factors which combine to offer a speedy and a reliable technique. Case report a middleaged woman suffered a closerange shotgun blast. Combining soft tissue reconstruction with bioprosthetic or synthetic mesh allows the. Learn about the rectus abdominis musculocutaneous flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. The rectus abdominis free flap is one of the most versatile softtissue flaps. The fascia of the rectus abdominis muscle is reinforced by the aponeuroses of the oblique abdominis muscles, which merge in the midline to form the dense fibrous linea alba. Reconstruction of complex groin defects with inferior epigastric arterybased rectus abdominis muscle flaps fig. The flap may be advantageous for cases in which a large tongue.
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. Figure 2 transverse rectus abdominis myocutaneous flap variants used for breast reconstructions, between august 2007 and august 2012, at the university hospital walter cantidio. The rectus abdominis myocutaneous flap smith 1998 cancer. The versatile deep inferior epigastric inferior rectus abdominis flap. Delayed soft tissue reconstruction with a horizontal. In 25 cadavers the width and length of the portions of rectus and transversus abdominis muscles suitable for the tramp flap as well as the length and diameter of the inferior epigastric artery. The authors present modified vertical rectus abdominis musculocutaneous vram flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Transverse rectus abdominis musculocutaneous flap radiology. Transverse rectus abdominus myocutaneous flap synonyms, transverse rectus abdominus myocutaneous flap pronunciation, transverse rectus abdominus myocutaneous flap translation, english dictionary definition of transverse rectus abdominus myocutaneous flap.
This muscle flexes the spinal column and trunk, which means it allows a person to bend forward. What is transverse rectus abdominis musculocutaneous flap reconstruction. The rectus abdominis myocutaneous flap to be described was successfully used in one such case. May 16, 2020 rectus abdominis, informally known as the abs muscle, is a long muscle of the anterior abdominal wall. When performing a rhinoplasty, the hump in the nose is removed. In the same year, robbins6 described this as a pedunculated flap. Transplantation of a transverse rectus abdominis myocutaneous tram flap is a commonly used surgical procedure for breast reconstruction following mastectomy an autologous myocutaneous flap consisting of abdominal skin, subcutaneous fat, the rectus abdominis muscle, and adjoining vasculature is used for reconstruction of the breast following mastectomy. Transverse rectus abdominis myocutaneous tram flap surgery was developed decades ago and is no longer recommended or performed at the johns hopkins breast center, because of the risk of hernia or abdominal bulge and the limit on lifting anything over 20 pounds post surgery. We report the case of a 43yearold female with necrotizing fasciitis of the right thigh, necessitating hip exarticulation and substantial debridement of necrotic tissue. An important area of weakness that should be recognized when securing abdominal closure after flap harvest. Definition of transverse rectus abdominis musculocutaneous flap reconstruction in the legal dictionary by free online english dictionary and encyclopedia.
The authors present their experience with a previously described but infrequently used variation of the rectus abdominis myocutaneous flap. A rectus abdominis myocutaneous flap to reconstruct abdominal. Rectus abdominis, informally known as the abs muscle, is a long muscle of the anterior abdominal wall. Action flexes trunk, aids forced expiration and raise intraabdominal pressure. They are commonly known as abdominals or abs muscles and are present in the pair at the front wall of the abdomen. Rectus abdominis belongs to the anterior abdominal muscles together with pyramidalis muscle. Insertion 5, 6, 7 costal cartilages, medial inferiorcostal margin and posterior aspect of xiphoid. Flap coverage of anterior abdominal wall defects ncbi. In the upper part, the anterior portion of the sheath is formed by the insertion of the external oblique and the internal oblique muscle, which splits, to form a deep and. The rectus abdominis free flap in head and neck reconstruction. Separation of the abdominal muscles diastasis or divarification of rectus abdominis muscles. The rectus abdominis muscle is contained in the rectus sheath, which consists of the aponeuroses of the lateral abdominal muscles.
Although the transverse rectus abdominis myocutaneous tram flap procedure has become popular as an option for breast reconstruction with patients following. The first version of the vertical rectus abdominis vram flap for breast reconstruction was reported by drever4 in 1977. Request pdf the oblique rectus abdominis musculocutaneous flap. It extends from the pubic symphysis, pubic crest and pubic tubercle inferiorly, to the. A large muscle in the front of the abdomen that assists in regular breathing movements, supports the muscles of the spine while a person lifts something, and keeps the intestines and other abdominal organs in place. In 1974, an upper transverse abdominal flap for breast reconstruction was described by tai and coworkers, who gave the first description of this myocutaneous flap based on the deep superior epigastric vessels and their perforating vessels through the rectus muscle. Physical therapy implications following the tram procedure. An ipsilateral horizontal rectus abdominis myocutaneous hram flap was used to cover the defect. The linea alba forms the medial border of this muscle and separates the two right and left. Skin paddles angled obliquely from the line of the rectus abdominis and toward the rib cage were successfully carried on periumbilical perforators from. In pregnancy, the tummy abdominal muscles stretch to.
Reconstruction of extensive abdominal wall defects is difficult in many cases. In those with low body fat, it is clearly visible beneath the skin forming the six pack. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap tramflap breast reconstruction. Separation of the abdominal muscles diastasis or divarification of rectus abdominis what is separation of the abdominal muscles. Vertical rectus abdominis musculocutaneous flowthrough. Another early report of flap raising procedures at the anterior abdominal wall including parts of the rectus muscle was given by brown et al. Rectus abdominis flap technique for head and neck reconstruction. Another early report of flap raising procedures at the anterior abdominal wall including parts of the rectus muscle was given by. How would a transverse rectus abdominis musculocutaneous flap be classified. Complications in breast reconstruction using a transverse. Rectus abdominis function, action, origin and insertion. The muscle is generally more developed in gym goers and athletes in whom the muscle. In 1979, holmstrom5 was the first to employ the free rectus abdominis musculocutaneous flap for breast reconstruction.
Reconstruction of abdominal wall defects using extended. Rbcp complications in breast reconstruction using a. Rectus abdominis free flap iowa head and neck protocols. New technical approach for the repair of an abdominal wall. Pdf bilateral anterior rectus sheath turnover flap for. Changes in the local morphology of the rectus abdominis muscle. This pdf is available for free download from a site hosted by. Get ready to learn all about this muscle, including its action. In the same year, robbins6 described this as a pe dunculated flap. Breast reconstruction with transverse rectus abdominis myocutaneous flap tram, single pedicle, including closure of donor site cpt code information is available to subscribers and includes the cpt code number, short description, long description, guidelines and more.
The muscle can be up to 30 cm long and up to 10 centimeters wide. During a pedicle flap mammoplasty reconstruction, a commonly used muscle is the. Although this muscle has a dual blood supply ie, the superior and inferior epigastric arteries, this operation relies only on the inferior epigastric arterial system. T1 vertical rectus abdominis musculocutaneous flowthrough flap to a free fibula flap for total sacrectomy reconstruction. Overtraining the rectus abdominis can make you less ef. Rectus abdominis is the muscle that runs vertically adjacent to the umbilicus along the whole abdomen from the sternum up to the pubic bone. The rectus abdominis muscle is the muscle located at the front of the abdomen that is most often called the abs or the sixpack. Abdominal wall reconstruction has become more common in the past 10 years.
Table 1 distribution of patients with and without postoperative complications according to the transverse rectus abdominis myocutaneous tram flap variant used. Such reconstructions may occur for blunt or penetrating abdominal trauma, abdominal compartment syndrome, wound dehiscence, intraperitoneal tumor resection, or complications of previous abdominal surgery such as hernias and mesh infections. Microvascular surgery protocols general considerations. Intercostal arterybased rectus abdominis transposition flap. The flap skin and fat of a free tram flap reconstruction survive on perforators through the rectus abdominis muscle. The oblique rectus abdominis musculocutaneous flap. However, this flap was only popularized in 1982 by hartrampf et al. Reconstruction of complex groin defects with inferior. The authors present 15 cases where intercostal arterybased rat flaps were used for sternal reconstruction over a span of 15 years. Firstly, the peritoneum is closed by free fascia lata transplantation. The anatomic basis of the transversus and rectus abdominis. Bands of connective tissue called the tendinous intersections traverse the rectus abdominis, which separates this parallel muscle into distinct muscle bellies.
This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Modifications of the technique that we utilize fig 1 76k include. Civil war 186165 ended slavery, but it left unanswered how the 11 southern states would conduct their internal affairs after readmission to the union. Revisited clinical applications the authors present their experience with a previously. Mar 03, 2016 the rectus abdominis flap is favored for this application because of its ease of harvest and reliability. The rectus abdominis muscle, also known as the abdominal muscle, is a paired muscle running vertically on each side of the anterior wall of the human abdomen, as well as that of some other mammals. Since its description in 1982 by hartrampf, this technique of reconstruction has. The breast surgeons at johns hopkins perform newer and more advanced.
Anterior abdominal wall crossectional anatomy and arcuate line when harvesting a rectus flap, the anterior rectus sheath is incised vertically over the. Although the vertical rectus abdominis myocutaneous flap is ideally suited to such. There are two parallel muscles, separated by a midline band of connective tissue called the linea alba. The anterior and posterior rectus sheaths merge in the midline to form the linea alba that separates the paired rectus muscles figure 1. It has been used extensively as both a pedicled and free flap for breast reconstruction.
It extends from the rib cage all the way to the pubic bone. Indications with the increased use of the forearm flap for intraoral and pharyngeal reconstruction, the rectus has been relegated to a secondline choice for reconstruction of these areas. The rectus abdominis musculocutaneous free flap, based on the deep inferior epigastric artery and vein, has been used widely in reconstruction of the breast and extremities. Meaning of transverse rectus abdominis musculocutaneous flap reconstruction as a legal term. Pdf breast reconstruction with autologous tissue transfer is now a standard operation, but. Learn about the rectus abdominis muscle flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. It extends from the rib cage all the way to the pubic bone rectus abdominis belongs to the anterior abdominal muscles together with pyramidalis muscle. A rectus abdominis myocutaneous flap to reconstruct. Choose from 116 different sets of rectus abdominis flashcards on quizlet. Although the transverse rectus abdominis musculocutaneous tram flap is the gold standard in autogenous breast reconstruction, it is less reliable in patients at high risk of ischaemic compromise. We will try to find the appropriate information as far as we can. Vertical rectus abdominis musculocutaneous flowthrough flap.
Skin paddles angled obliquely from the line of the rectus abdominis and toward the rib cage were successfully carried on periumbilical perforators from the inferior epigastric system. Pdf laparoscopic transverse rectus abdominus flap delay. The multiple diagrams shown here include mcburneys point, dysmenorrhea menstrual period, and pyramidalis. Transverse rectus abdominus myocutaneous flap synonyms, transverse rectus abdominus myocutaneous flap pronunciation, transverse rectus abdominus myocutaneous flap. Pdf laparoscopic transverse rectus abdominus flap delay for. The muscle is enclosed by the rectus sheath, but below the arcuate line, this sheath disappears posterior to the muscle. Nov 07, 2014 the rectus abdominis muscle is located in the front of the body, beginning at the pubic bone and ending at the sternum. Rectus abdominis trigger point diagram, pain patterns and related medical symptoms. Cramer, in clinical anatomy of the spine, spinal cord, and ans third edition, 2014. The aim of this study was to provide an anatomic basis for the transversus and rectus abdominis musculoperitoneal tramp flap, recently successfully introduced for vulvovaginal reconstruction. Apr 16, 2008 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.