title: Repair of duodenal fistula with rectus abdominis musculo-peritoneal (RAMP) flap.
abstract: BACKGROUND
  Large duodenal defects/fistulae are difficult to repair, due to complex duodenal anatomy. Musculo-epithelial flaps are conventionally used for reconstruction of large soft tissue defects. We report the clinical use of rectus abdominis musculo-peritoneal (RAMP) flap for repair of duodenal fistulae.
  
  
  METHODS
  Eight patients with duodenal fistulae underwent repair using right RAMP flap, based on the position of the superior epigastric artery. Feeding jejunostomy was done routinely to start early enteral feeding.
  
  
  RESULTS
  Duodenal fistulae healed within 3-5 days in all the cases except one, in whom bile continued to leak for 30 days. One patient died within 12 hours of second surgery. Superficial wound infection was a common (n=3) cause of morbidity.
  
  
  CONCLUSIONS
  RAMP flap for closure of duodenal defect is a simple, technically easy and dependable procedure, which can be performed quickly in critically ill patients. It can be used for repair of large duodenal defects with friable edges when omentum is not available or when other conventional methods are impractical.
authors.affiliation: Plastic Surgery Unit, Department of Surgery, Government NSCB Medical College, Jabalpur-482 003, India.
authors.forename: Pawan
authors.initials: P
authors.lastname: Agarwal
authors.forename: Dhananjaya
authors.initials: D
authors.lastname: Sharma
mesh_terms: D004378:Duodenal Diseases / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D010537:Peritoneum / Q000637:transplantation; D011379:Prognosis; D017568:Rectus Abdominis / Q000637:transplantation; D018570:Risk Assessment; D012494:Sampling Studies; D013524:Surgical Flaps; D016896:Treatment Outcome