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Related Experiment Videos

Extended TRAM flap: feasibility study on fresh human cadavers.

Michael R Zenn1, Christoph Heitmann

  • 1Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC 27710, USA. Michael.Zenn@duke.edu

Annals of Plastic Surgery
|June 13, 2003
PubMed
Summary

This study explored a new breast reconstruction method using an extended TRAM flap (eTRAM) without microsurgery. Anatomical investigation suggests this flap is feasible, potentially expanding reconstructive options.

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Area of Science:

  • Plastic Surgery
  • Surgical Anatomy
  • Reconstructive Surgery

Background:

  • Transverse Rectus Abdominis Myocutaneous (TRAM) flaps are a common method for breast reconstruction.
  • Current techniques may involve microsurgery or have limitations in pedicle length.

Purpose of the Study:

  • To investigate the feasibility of a superiorly based TRAM flap for breast reconstruction, utilizing the superior epigastric vessels.
  • To assess the surgical anatomy of an extended TRAM flap (eTRAM) requiring partial rib resection for pedicle lengthening.

Main Methods:

  • Anatomical study involving bilateral cannulation and latex injection of the internal mammary artery (IMA) in 10 fresh human cadavers.
  • Dissection of the IMA's intrathoracic course to identify the superior epigastric artery's origin and trajectory.

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Main Results:

  • The mean external diameters of the right and left IMA were measured at the third intercostal space (2.5 mm and 2.3 mm, respectively).
  • The superior epigastric artery's origin and course were mapped, noting its diameter (1.6 mm) and separation from the diaphragm.
  • The study confirmed the superior epigastric artery's path into the rectus abdominis muscle without violating the thoracic cavity.

Conclusions:

  • The anatomical findings support the feasibility of raising an extended TRAM (eTRAM) flap after partial rib resection.
  • This modification offers a potential alternative to microsurgery for breast reconstruction.
  • The eTRAM flap may broaden applications in chest wall, intrathoracic, and head and neck reconstruction.