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The extraperitoneal laparoscopic TRAM flap delay procedure: an alternative approach
Panduranga Yenumula1, Erick F Rivas, Keith M Cavaness
1Department of Surgery, Michigan State University, Lansing, MI 48912, USA. panduranga.yenumula@hc.msu.edu
Surgical Endoscopy
|August 25, 2010
Summary
The extraperitoneal laparoscopic technique (EPLT) for deep inferior epigastric artery ligation before transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction is safe and effective. This minimally invasive approach reduces complications associated with TRAM flap surgery.
Area of Science:
- Surgical Oncology
- Plastic and Reconstructive Surgery
Background:
- Deep inferior epigastric vessel ligation (delay procedure) augments TRAM flap vascularity via improved superior epigastric flow, reducing flap morbidity.
- Surgical approaches for this ligation include open and laparoscopic methods.
Purpose of the Study:
- To describe an extraperitoneal laparoscopic technique (EPLT) for deep inferior epigastric artery ligation.
- To evaluate the outcomes and safety of EPLT in TRAM flap reconstruction.
Main Methods:
- Retrospective analysis of a prospectively collected database.
- Inclusion of all patients undergoing EPLT prior to TRAM flap construction between July 2006 and December 2008.
Main Results:
- 11 female patients (mean age 55 years, mean BMI 34.4 kg/m²) were included.
- No conversions to open procedures were necessary.
- 10 patients had bilateral ligation, one had unilateral; no procedure-related complications occurred.
Conclusions:
- The extraperitoneal laparoscopic technique (EPLT) is a safe and feasible delay procedure for TRAM flap reconstruction.
- EPLT demonstrates no surgical morbidity, offering a viable alternative for TRAM flap preparation.