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Arterial vascular anatomy of the umbilicus
R B Stokes1, T P Whetzel, E Sommerhaug
1Division of Plastic and Reconstructive Surgery, University of California, Davis, Medical Center, Sacramento 95817, USA.
Plastic and Reconstructive Surgery
|September 4, 1998
Summary
Umbilical necrosis after TRAM flap surgery is rare. This study reveals the umbilicus
Area of Science:
- Plastic Surgery
- Anatomy
- Vascular Surgery
Background:
- Umbilical necrosis is a rare complication following transverse rectus abdominis muscle (TRAM) flap procedures.
- Understanding the umbilicus' arterial supply is crucial for minimizing this risk.
Purpose of the Study:
- To investigate the deep arterial anatomy of the umbilicus.
- To correlate anatomical findings with clinical outcomes in TRAM flap surgery.
Main Methods:
- Dissection of blue latex-injected specimens from 16 fresh cadavers.
- Radiography of barium latex-injected specimens.
- Selective ink injection of individual perforators.
Main Results:
- The umbilicus receives arterial inflow from three distinct deep sources: deep inferior epigastric arteries, ligamentum teres hepaticum, and median umbilical ligament.
- Deep inferior epigastric arteries provide multiple branches and a large ascending branch to the umbilicus.
- Bilateral TRAM flaps remove all major deep arterial sources, leaving only smaller vessels from the ligamentum teres and median umbilical ligament.
Conclusions:
- Unilateral TRAM flaps should maintain robust umbilical blood supply from the contralateral deep inferior epigastric arteries.
- Careful preservation of the ligamentum teres and median umbilical ligament arterial sources is essential during bilateral TRAM flap creation to prevent umbilical necrosis.