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Related Experiment Videos

TRAM flap safety optimized with intraoperative Doppler.

B J Michelow1, C R Hartrampf, G K Bennett

  • 1Department of Plastic and Reconstructive Surgery, St. Joseph Hospital, Atlanta, GA.

Plastic and Reconstructive Surgery
|July 1, 1990
PubMed
Summary

A Doppler probe helps surgeons safely identify deep superior epigastric vessels for TRAM flap surgery. This technique ensures precise dissection, enabling competent abdominal closure and improving patient outcomes.

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The double pedicle TRAM flap and the standard of care.

Plastic and reconstructive surgery·1998

Area of Science:

  • Surgical Anatomy
  • Vascular Surgery
  • Plastic Surgery

Background:

  • Anatomical variations of deep superior epigastric vessels within the rectus abdominis muscle are well-documented.
  • Accurate identification of the vascular pedicle is crucial for successful TRAM flap reconstruction.
  • Previous methods may lack precision in locating these vessels.

Purpose of the Study:

  • To evaluate the utility of a Doppler probe in identifying the deep superior epigastric vascular axis.
  • To determine if Doppler guidance facilitates a safer and more conservative dissection for TRAM flaps.
  • To assess the impact of Doppler-guided dissection on the integrity of the rectus abdominis muscle and abdominal closure.

Main Methods:

  • Utilized a Doppler probe to locate the dominant intramuscular vascular axis of the deep superior epigastric vessels.

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  • Employed Doppler guidance during the dissection of the vascular pedicle and associated rectus abdominis muscle.
  • Documented the vessel's position relative to the costal margin and within the muscle.

    • Main Results:

    • The Doppler probe reliably identified the deep superior epigastric vascular pedicle in all patients.
    • The technique accurately alerted surgeons to unusual vessel positions.
    • Doppler-guided dissection allowed for conservative harvesting of the muscle segment containing the vascular pedicle.

    Conclusions:

    • The Doppler probe is a safe, simple, and effective tool for pre-operative and intra-operative localization of the deep superior epigastric vessels.
    • This method enables a precise and conservative dissection, ensuring the viability of the TRAM flap and facilitating secure abdominal closure.
    • The Doppler technique is noninvasive, quick, and universally applicable in TRAM flap surgery.