title: Myosonographic study of abdominal wall dynamics to assess donor site morbidity after microsurgical breast reconstruction with a DIEP or an ms-2 TRAM flap.
abstract: BACKGROUND
  Currently, autologous breast reconstruction with a free tissue transfer from the lower abdomen is considered to be a safe method that provides a stable long-term solution. The DIEP-flap and the ms-2-TRAM-flap reconstructions have helped reduce donor site morbidity. In order to assess the potential differences between these techniques, we carried out myosonographic evaluations that assessed the muscle dynamics pre- and post-operatively. In addition to investigating the properties of the rectus abdominis muscle post-operatively, this prospective study also allowed us to analyse the muscle preoperatively and to investigate the prospects for harvesting a DIEP-flap as opposed to a TRAM-flap.
  
  
  METHODS
  Sixty patients underwent breast reconstruction with 71 (11 bilateral) free abdominal wall flaps (DIEP-: n = 48; ms-2-TRAM-flap: n = 23). Myosonographic examinations were performed preoperatively and at 3 and 6 months post-operatively. The thickness of the muscle at relaxation and maximum contraction and the difference between the muscle thickness measured at the two states were measured. A general-linear-model (GLM) was used for statistical analysis. The main variable was the surgical method, and the co-variables included BMI and patient age. The decision on whether to harvest a DIEP- or ms-2-TRAM-flap was made intra-operatively and based on the dominant perforator.
  
  
  RESULTS
  It shows that the patients who underwent breast reconstruction with a DIEP-flap had significantly better muscle function (p < 0.05) in the follow-up. In addition, the analysis revealed that better muscle function before surgery made it more likely that a patient would undergo a DIEP-flap-reconstruction successfully. Patient age also had a highly significant effect on muscle recovery (p < 0.0005).
  
  
  CONCLUSIONS
  This prospective study used a dynamic ultrasound evaluation of the abdominal wall and showed that the DIEP-flap significantly reduces donor site morbidity compared to the ms-2-TRAM-flap. The study also showed that good preoperative muscle function might increase the probability of surgeons performing a DIEP-flap reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Brussel UZ, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Seidenstuecker
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sana Krankenhaus, Gräulinger Str. 125, 40625, Düsseldorf, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Legler
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sana Krankenhaus, Gräulinger Str. 125, 40625, Düsseldorf, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Munder
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sana Krankenhaus, Gräulinger Str. 125, 40625, Düsseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Andree
authors.affiliation: Bradford Royal Infirmary Teaching Hospitals, Duckworth Lane, Bradford, West Yorkshire, BD9 6RJ, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: Plastic and Reconstructive Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. Electronic address: christian.witzel@charite.de.
authors.forename: C
authors.initials: C
authors.lastname: Witzel
mesh_terms: D034861:Abdominal Wall / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data; D008866:Microsurgery; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D009126:Muscle Relaxation / Q000502:physiology*; D061525:Perforator Flap / Q000502:physiology / Q000637:transplantation*; D057234:Preoperative Period; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology*; D020858:Tissue and Organ Harvesting / Q000379:methods; D060053:Transplant Donor Site / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology*; D014182:Transplantation, Autologous; D014463:Ultrasonography
keywords: Abdominal wall study; Breast reconstruction; DIEP flap; Donor site morbidity; TRAM flap