LENGTHENED PEDICLE OF RECTUS ABDOMINIS FLAP TO REPAIR DEFECT ON NECK AND CHEST_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGJiaqi ,  ZHANGJinming , LIANGWeiqiang , JIChenyang , PANShujuan , CHENYuhong , GAOShouquan , YAOYuanyuan

Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510120, P. R. China;

Corresponding author：

ZHANGJinming, Email: zxmrwk@126.com

Keywords：

Pedicled rectus abdominis flap; Costicartilage; CT angiography; Wound repair

DOI：

10.7507/1002-1892.20140297

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the feasibil ity to repair defect on the neck and chest with the rectus abdominis flap which pedicle is lengthened by measuring the width, thickness, and the intercostal space of the inferior costicartilage using CT angiography (CTA). Methods Thirty cases receiving CTA and three-dimensional reconstruction between July and December 2013 were included in the study. Of 30 cases, 17 were male and 13 were female, aged 44-70 years (mean, 56 years). The width and thickness of the 3rd to 7th costicartilages and the distance of the 3rd to 6th intercostal spaces were measured, and the lengthened pedicle was calculated after the 4th to 7th costicartilage was cut off. Between July 2012 and November 2013, the lengthened pedicle of the rectus abdominis flap was cl inically used to repair the defect on the neck and chest in 4 cases. Results The pedicle of the rectus abdominis flap was about 6 cm in length. When the left 7th, 6th, 5th, and 4th costicartilages were cut off, the average pedicle was lengthened by 4.07, 7.99, 12.50, and 17.48 cm respectively; when the right 7th, 6th, 5th, and 4th costicartilages were cut off, the average pedicle was lengthened by 4.63, 10.82, 16.64, and 22.05 cm respectively. In 4 flaps which were cl inically used to repair defects, 3 flap completely survived, 1 flap had partial necrosis. Three patients were followed up 6 months, and the appearance and texture of the flap were satisfactory; 1 patient failed to be followed up. Conclusion Resecting the inferior costicartilage can prolong the pedicle of the rectus abdominis flap, therefore it can be used to repair defect on the upper chest and the neck.

Citation： ZHANGJiaqi, ZHANGJinming, LIANGWeiqiang, JIChenyang, PANShujuan, CHENYuhong, GAOShouquan, YAOYuanyuan. LENGTHENED PEDICLE OF RECTUS ABDOMINIS FLAP TO REPAIR DEFECT ON NECK AND CHEST. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(11): 1372-1375. doi: 10.7507/1002-1892.20140297 Copy

1.	Bakri K, Mardini S, Evans KK, et al. Workhorse flaps in chest wall reconstruction:the pectoral is major, latissimus dorsi, and rectus abdominis flap. Semin Plast Surg, 2011, 25(1):43-54.
2.	韩久卉, 张英泽.乳房切除后乳房再造的意义及现状.中华整形外科杂志, 2004, 20(6):468-471.
3.	Zenn MR, Heitmann C. Extended TRAM flap:feasibil ity study on fresh human cadavers. Ann Plast Surg, 2003, 50(3):256-262.
4.	Rozen WM, Ashton MW, Grinsell D, et al. Establishing the case for CT angiography in the preoperative imaging of abdominal wall perforates. Microsurgery, 2008, 28(5):306-313.
5.	Cordeiro PG. Breast reconstruction after surgery for breast cancer. N Engl J Med, 2008, 359(15):1590-1601.
6.	Codner MA, Bostwick J 3rd, Nahai F, et al. TRAM flap vascular delay for high risk breast reconstruction. Plast Reconstr Surg, 1995, 96(7): 1615-1622.
7.	Li S, Mu L, Li Y, et al. Breast reconstruction with the free bi pedicled inferior TRAM flap by anastomosis to the proximal and distal ends of the internal mammary vessels. J Reconstr Microsurg, 2002, 18(3):161-168.
8.	Pernia LR, Miller HL, Saltz R, et al. "Supercharging" the rectus abdominis muscle to provide a single flap for cover of large mediastinal wound defects. Br J Plast Surg, 1991, 44(4):243-246.
9.	Yamamoto Y, Nohira K, Shintomi Y, et al. "Turbo charging" the vertical rectus abdominis myocutaneous (turbo-VRAM) flap for reconstruction of extensive chest wall defects. Br J Plast Surg, 1994, 47(2):103-107.
10.	Grotting JC. Immediate breast reconstruction using the free TRAM flap. Clin Plast Surg, 1994, 21(2):207-221.
11.	Grotting JC, Urist MM, Maddox WA, et al. Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction. Plast Reconstr Surg, 1989, 83(5):828-844.
12.	Schusterman MA, Kroll SS, Weldon ME. Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap? Plast Reconstr Surg, 1992, 90(2):255-262.
13.	Tachi M, Yamada A. Choice of flaps for breast reconstruction. Int J Clin Oncol, 2005, 10(5):289-297.
14.	Scheflan M, Dinner MI. The transverse abdominal island flap:part I. Indications, contraindications, results, and complications. Ann Plast Surg, 1983, 10(1):24-35.
15.	Wallace CG, Mao HY, Wang CJ, et al. Three-dimensional computed tomography reveals different donor-site deformities in adult and growing microtia patients despite total subperichondrial costal cartilage harvest and donor-site reconstruction. Plast Reconstr Surg, 2013, 133(3):640-651.
16.	Noda M, Endo C, Hosaka T, et al. Dedifferentiated chondrosarcoma of the chest wall:reconstruction with polypropylene mesh using a transverse rectus abdominis myocutaneous flap. Gen Thorac Cardiovasc Surg, 2011, 59(3):199-201.
17.	Osawa H, Nishii T, Suzuki Y, et al. Experience of chest wall reconstruction with newly developed material. Kyobu Geka, 2008, 61(12):1023-1025.
18.	Sodha NR, Azoury SC, Sciortino C, et al. The use of acellular dermal matrices in chest wall reconstruction. Plast Reconstr Surg, 2012, 130(5S-2):175S-182S.

1. Bakri K, Mardini S, Evans KK, et al. Workhorse flaps in chest wall reconstruction:the pectoral is major, latissimus dorsi, and rectus abdominis flap. Semin Plast Surg, 2011, 25(1):43-54.
2. 韩久卉, 张英泽.乳房切除后乳房再造的意义及现状.中华整形外科杂志, 2004, 20(6):468-471.
3. Zenn MR, Heitmann C. Extended TRAM flap:feasibil ity study on fresh human cadavers. Ann Plast Surg, 2003, 50(3):256-262.
4. Rozen WM, Ashton MW, Grinsell D, et al. Establishing the case for CT angiography in the preoperative imaging of abdominal wall perforates. Microsurgery, 2008, 28(5):306-313.
5. Cordeiro PG. Breast reconstruction after surgery for breast cancer. N Engl J Med, 2008, 359(15):1590-1601.
6. Codner MA, Bostwick J 3rd, Nahai F, et al. TRAM flap vascular delay for high risk breast reconstruction. Plast Reconstr Surg, 1995, 96(7): 1615-1622.
7. Li S, Mu L, Li Y, et al. Breast reconstruction with the free bi pedicled inferior TRAM flap by anastomosis to the proximal and distal ends of the internal mammary vessels. J Reconstr Microsurg, 2002, 18(3):161-168.
8. Pernia LR, Miller HL, Saltz R, et al. "Supercharging" the rectus abdominis muscle to provide a single flap for cover of large mediastinal wound defects. Br J Plast Surg, 1991, 44(4):243-246.
9. Yamamoto Y, Nohira K, Shintomi Y, et al. "Turbo charging" the vertical rectus abdominis myocutaneous (turbo-VRAM) flap for reconstruction of extensive chest wall defects. Br J Plast Surg, 1994, 47(2):103-107.
10. Grotting JC. Immediate breast reconstruction using the free TRAM flap. Clin Plast Surg, 1994, 21(2):207-221.
11. Grotting JC, Urist MM, Maddox WA, et al. Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction. Plast Reconstr Surg, 1989, 83(5):828-844.
12. Schusterman MA, Kroll SS, Weldon ME. Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap? Plast Reconstr Surg, 1992, 90(2):255-262.
13. Tachi M, Yamada A. Choice of flaps for breast reconstruction. Int J Clin Oncol, 2005, 10(5):289-297.
14. Scheflan M, Dinner MI. The transverse abdominal island flap:part I. Indications, contraindications, results, and complications. Ann Plast Surg, 1983, 10(1):24-35.
15. Wallace CG, Mao HY, Wang CJ, et al. Three-dimensional computed tomography reveals different donor-site deformities in adult and growing microtia patients despite total subperichondrial costal cartilage harvest and donor-site reconstruction. Plast Reconstr Surg, 2013, 133(3):640-651.
16. Noda M, Endo C, Hosaka T, et al. Dedifferentiated chondrosarcoma of the chest wall:reconstruction with polypropylene mesh using a transverse rectus abdominis myocutaneous flap. Gen Thorac Cardiovasc Surg, 2011, 59(3):199-201.
17. Osawa H, Nishii T, Suzuki Y, et al. Experience of chest wall reconstruction with newly developed material. Kyobu Geka, 2008, 61(12):1023-1025.
18. Sodha NR, Azoury SC, Sciortino C, et al. The use of acellular dermal matrices in chest wall reconstruction. Plast Reconstr Surg, 2012, 130(5S-2):175S-182S.

Chinese Journal of Reparative and Reconstructive Surgery

LENGTHENED PEDICLE OF RECTUS ABDOMINIS FLAP TO REPAIR DEFECT ON NECK AND CHEST

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content