title: Double-mesh technique for correction of abdominal hernia following mammary reconstruction carried out with bipedicled TRAM flap and the primary closing of the donor area by using a single polypropylene mesh.
abstract: BACKGROUND
  Mammary reconstruction by using the transverse myocutaneous flap of the abdominal straight muscle (TRAM) is still an option well accepted in many parts of the world. However, bipedicled TRAM flaps are associated with greater morbidity of the abdominal donor area. The aim of this study was to describe an efficient technique for correcting the delayed defects of the abdominal wall following mammary reconstruction carried out with bipedicled TRAM flaps by using two polypropylene prostheses overlapped in different anatomical planes.
  
  
  METHODS
  At Hospital Estadual Sumaré at Universidade Estadual de Campinas, 18 women who underwent unilateral mammary reconstruction with bipedicled TRAM flaps and immediate fixation of two rectangular flaps of polypropylene mesh on the donor area were assessed. Later on, three patients (16.7%) presented with deformity of the anterolateral abdominal wall in the donor area. Each of these herniations was corrected by fixing two polypropylene meshes in different anatomical planes: the first mesh, which was bigger and preperitoneal, was fixed from the costal borders until the pubis; the second mesh was fixed from the external oblique muscle to the contralateral external oblique muscle, remaking the median line.
  
  
  RESULTS
  All patients were followed up for at least 18 months, without any signs of relapse, abdominal asymmetry, or chronic pain and with satisfactory functional results.
  
  
  CONCLUSIONS
  The correction of delayed deformities of the abdominal wall after mammary reconstruction with bipedicled TRAM flaps using double mesh was carried out in an effective and secure way, providing an interesting surgical option for mastologists and plastic and general surgeons.
authors.affiliation: Department of Surgery, School of Medical Sciences, Universidade de Marília, São Paulo, CEP, Brazil. lrmsouto@yahoo.com.br
authors.forename: Luís Ricardo Martinhão
authors.initials: LR
authors.lastname: Souto
authors.forename: Luiz Antonio Athayde
authors.initials: LA
authors.lastname: Cardoso
authors.forename: Bruno Marino
authors.initials: BM
authors.lastname: Claro
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: de Oliveira Peres
mesh_terms: D050153:Abdominal Fat / Q000601:surgery / Q000637:transplantation; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011126:Polypropylenes; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D017568:Rectus Abdominis / Q000601:surgery / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000098:blood supply*; D013526:Surgical Mesh; D013718:Tensile Strength; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D011126:Polypropylenes