The Rectus Abdominis Perforator Turndown Flap for Preserving Rectus Continuity: A DIEP Alternative?

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Surgical Innovation

Background:

• Deep inferior epigastric artery perforator (DIEP) flaps are preferred for breast reconstruction over transverse rectus abdominis myocutaneous (TRAM) flaps due to muscle sparing and lower donor site morbidity.
• However, DIEP flaps present challenges in vascular dissection, potentially leading to perfusion complications and longer operative times.
• The TRAM flap offers easier dissection and vascularity but sacrifices rectus abdominis muscle continuity.

Purpose of the Study:

• To pilot a novel technique combining the advantages of TRAM and DIEP flaps.
• To assess the feasibility of preserving rectus abdominis muscle continuity following TRAM flap harvest.
• To introduce the innervated rectus abdominis perforator turndown (RAPT) flap for rectus abdominis reconstruction.

Main Methods:

• A cohort of six patients underwent free TRAM flap surgery.
• Segmental, periumbilical rectus abdominis muscle was harvested.
• The resulting defect was reconstructed using a supraumbilically harvested, innervated RAPT flap.
• Postoperative assessment included clinical evaluation, electromyography, and ultrasound to confirm rectus continuity and function.

Main Results:

• All six TRAM flap transfers were successful without flap-related complications.
• Rectus abdominis muscle reconstruction using the RAPT flap was achieved in all cases.
• Successful restoration of rectus abdominis muscle continuity and function was confirmed postoperatively.

Conclusions:

• The innervated RAPT flap is a viable technique for rectus abdominis continuity reconstruction after TRAM flap harvest.
• This method potentially offers the surgical ease and vascularity of the TRAM flap.
• It also provides the benefit of preserving rectus abdominis muscle continuity, similar to the DIEP flap.