title: Anterior rectus fascia back cut: a new modification to relieve the pressure in fascial closure of the superior pedicle of a transverse rectus abdominis myocutaneous flap.
abstract: The maintenance of vascular patency is one of the key points to be considered after a pedicled transverse rectus abdominis myocutaneous (TRAM) flap has been raised and when closing the anterior rectus fascia to avoid a hernia. In this study we describe a new approach to closing the most superior part of the fascia to help insure vascular patency. Forty patients who had their breasts reconstructed with TRAM flaps made up the study group. The new back cut technique was used in 25 patients. Of the remaining 15 patients, four required early revision on the day of operation for severe venous congestion or ischaemia. None of the patients who had the back cut technique required early revision. We found the back cut technique to be safe and easy, and we think that it can reduce the incidence of flap ischaemia and still achieve tight fascial closure.
authors.affiliation: Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel. fredricag@asaf.health.gov.il
authors.forename: Avshalom
authors.initials: A
authors.lastname: Shalom
authors.forename: Ophir
authors.initials: O
authors.lastname: Schein
authors.forename: Melvyn
authors.initials: M
authors.lastname: Westreich
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007557:Israel; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D017568:Rectus Abdominis / Q000098:blood supply / Q000601:surgery / Q000637:transplantation*; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D040521:Subcutaneous Tissue / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D013536:Suture Techniques; D013718:Tensile Strength; D060053:Transplant Donor Site / Q000601:surgery*; D016896:Treatment Outcome