title: Unipedicle TRAM flap procedures are associated with symptoms of pelvic floor dysfunction in women: a case control study.
abstract: OBJECTIVE
  Chronic conditions that cause raised intra-abdominal pressure, such as obesity, chronic cough and constipation are risk factors for pelvic floor dysfunction (PFD). We hypothesise that unipedicle transverse rectus abdominis musculocutaneous flap (UTRAM flap) for reconstruction following mastectomy for breast cancer increases the risk of PFD.
  
  
  OBJECTIVE
  The aim of this study is to assess if there is increased risk of pelvic floor dysfunction associated with UTRAM flap reconstruction compared to controls.
  
  
  METHODS
  39 patients who had UTRAM flaps for breast reconstruction following mastectomy for breast cancer between year 1997 to 2004 were recruited as cases. They were matched by age with 36 controls, who have had breast cancer but not U TRAM flap reconstruction as part of their treatment. Validated questionnaires (Pelvic floor distress inventory PFDI-20) were completed by study participants, and demographic data were also collected. Mixed effect analysis of variance was used to assess for statistical difference in the mean PFDI-20 scores, adjusted by age, parity, BMI and history of gynaecological surgery.
  
  
  RESULTS
  The case group has significantly higher mean PFDI-20 score than the control group, 13 (3-29) vs 5.5 (1-11), MH odds ratio 1.8 (1.1-2.8), p value=0.02.
  
  
  CONCLUSIONS
  Women who have undergone U TRAM flap reconstruction appeared to have more symptoms of PFD, compared to women who did not have the procedure. It is likely that the reduction in volume of abdomen, following surgery leads to an increase in intra-abdominal pressure (IAP) which predisposes these women to PFD. Future work to assess changes in IAP is proposed.
authors.affiliation: Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand. Chiachia.liu@gmail.com.
authors.forename: Emily
authors.initials: E
authors.lastname: Liu
authors.forename: Jackie
authors.initials: J
authors.lastname: Smalldridge
authors.forename: Belinda
authors.initials: B
authors.lastname: Scott
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015187:Lipectomy; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000209:etiology* / Q000601:surgery; D017568:Rectus Abdominis / Q000637:transplantation*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires