title: New technical approach for the repair of an abdominal wall defect after a transverse rectus abdominis myocutaneous flap: a case report.
abstract: BACKGROUND
  Breast reconstruction with autologous tissue transfer is now a standard operation, but abnormalities of the abdominal wall contour represent a complication which has led surgeons to invent techniques to minimize the morbidity of the donor site.
  
  
  METHODS
  We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap (TRAM-flap) breast reconstruction. The surgery led to the patient developing an enormous abdominal bulge that caused her disability in terms of abdominal wall and bowel function, pain and contour. In the absence of rectus muscle, the large defect was repaired using a combination of the abdominal wall component separation technique of Ramirez et al and additional mesh augmentation with a lightweight, large-pore polypropylene mesh (Ultrapro).
  
  
  CONCLUSIONS
  The procedure of Ramirez et al is helpful in achieving a tension-free closure of large defects in the anterior abdominal wall. The additional mesh augmentation allows reinforcement of the thinned lateral abdominal wall.
authors.affiliation: Department of Surgery, Medical Faculty, Rheinish-Westphalian Technical University, Aachen, Germany. dkaemmer@ukaachen.de
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Kaemmer
authors.forename: Joachim
authors.initials: J
authors.lastname: Conze
authors.forename: Jens
authors.initials: J
authors.lastname: Otto
authors.forename: Volker
authors.initials: V
authors.lastname: Schumpelick