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Innervation of the rectus abdominis muscle: implications for rectus flaps
J Duchateau1, A Declety, M Lejour
1Department of Plastic Surgery, Hôpital Universitaire Brugmann, Brussels, Belgium.
Plastic and Reconstructive Surgery
|August 1, 1988
Summary
Leaving lateral rectus abdominis muscle strips during TRAM flap surgery does not preserve muscle function. Cadaver dissection and CT scans show these parts are denervated and undergo fibrosis, questioning their usefulness.
Area of Science:
- Plastic Surgery
- Anatomy
- Surgical Oncology
Background:
- The transverse rectus abdominis musculocutaneous (TRAM) flap is a common breast reconstruction technique.
- The role of preserving lateral rectus abdominis muscle strips during TRAM flap surgery remains unclear.
- Existing anatomical descriptions of intercostal nerve pathways in the rectus abdominis muscle are inconsistent.
Purpose of the Study:
- To investigate the anatomical course of intercostal nerves supplying the rectus abdominis muscle.
- To determine if preserving lateral muscle strips during TRAM flap surgery maintains muscle function.
Main Methods:
- Dissection of six fresh cadavers to trace intercostal nerve entry into the rectus abdominis muscle.
- CT scans of the abdominal wall in 10 patients post-TRAM flap surgery to assess muscle viability.
Main Results:
- Intercostal nerves consistently enter the deep surface of the rectus abdominis muscle in its central portion.
- Lateral muscle strips, often preserved in TRAM flaps, are denervated.
- CT scans revealed progressive fibrosis and muscle atrophy in the preserved lateral rectus abdominis muscle segments over time.
Conclusions:
- Partial preservation of the rectus abdominis muscle during TRAM flap surgery does not maintain its functional integrity.
- The preservation of lateral rectus abdominis muscle strips is unlikely to benefit patients in terms of muscle function.