Semin Plast Surg 2002; 16(1): 119-130
DOI: 10.1055/s-2002-22689
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Abdominal Donor Site Morbidity: Impact of the TRAM and DIEP Flap on Strength and Function

Catriona M. Futter
  • Department of Physiotherapy, West of Scotland Regional Plastic and Maxillofacial Surgery Unit, Canniesburn Hospital, Glasgow, United Kingdom
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Publikationsverlauf

Publikationsdatum:
22. März 2002 (online)

ABSTRACT

Abdominal complications following breast reconstruction with a pedicled transverse rectus abdominus myocutaneous (TRAM) flap include decreased abdominal strength, bulge and hernia, pain, and difficulty with lifting, housework, work, and sport. Research work has shown that the muscle-sparing free TRAM flap does not necessarily prevent these complications, as removing a portion of one rectus abdominis reduces the integrity of the whole donor muscle. The deep inferior epigastric perforator (DIEP) flap was developed in an attempt to minimize donor site morbidity, and trials that have been conducted comparing the free TRAM and DIEP flaps suggest that the DIEP flap does have less impact on abdominal muscle strength and function, although problems can still occur. Recent work by the author confirms that the DIEP flap does reduce donor site morbidity and that an additional benefit in terms of a subjective improvement in outcome can be obtained from preoperative abdominal exercises. Progressive postoperative abdominal exercises and advice on posture and returning to functional activities from a physiotherapist familiar with the surgical techniques are recommended to ensure optimal outcome.

REFERENCES

  • 1 Fleck S J, Kraemer W J. Designing Resistance Training Programs, 2nd ed.  Champagne, IL: Human Kinetics 1997: 23-27
  • 2 Norris C M. Back Stability. Champagne, IL: Human Kinetics 1997: 57-69
  • 3 Scheflan M, Kalisman M. Complications of breast reconstruction.  Clin Plast Surg . 1984;  11 343-350
  • 4 Hartrampf C R, Bennett K. Autogenous tissue reconstruction in the mastectomy patient-a critical review of 300 patients.  Ann Surg . 1987;  205 508-518
  • 5 Lejour M, Dome M. Abdominal wall function after rectus abdominis transfer.  Plast Reconstr Surg . 1991;  87 1054-1068
  • 6 Kroll S S, Marchi M. Comparison of strategies for preventing abdominal wall weakness after TRAM flap breast reconstruction.  Plast Reconstr Surg . 1992;  89 1045-1053
  • 7 Mizgala C L, Hartrampf C R, Bennett G K. Assessment of the abdominal wall after pedicled TRAM flap surgery: 5 to 7 year follow up of 150 consecutive patients.  Plast Reconstr Surg . 1994;  93 988-1002
  • 8 Petit J Y, Rietjens M, Ferreira M A, Montrucoli D, Lifrange E, Martinelli P. Abdominal sequelae after pedicled TRAM flap breast reconstruction.  Plast Reconstr Surg . 1997;  99 723-729
  • 9 Kroll S S, Schusterman M A, Reece G P, Miller M J, Robb G, Evans G. Abdominal wall strength, bulging and hernia after TRAM flap breast reconstruction.  Plast Reconstr Surg . 1995;  96 616-619
  • 10 Suominen S, Asko-Seljavaara S, Von Smitten K, Ahovuo J, Sainio P, Alaranta H. Sequelae in the abdominal wall after pedicled or free TRAM flap surgery.  Ann Plast Surg . 1996;  36 629-636
  • 11 Kind G M, Rademaker A W, Mustoe T A. Abdominal wall recovery following TRAM flap: a functional outcome study.  Plast Reconstr Surg . 1997;  99 417-428
  • 12 Suominen S, Asko-Seljavaara S, Kinnunen J, Sainio P, Alaranta H. Adbominal wall competence after free transverse rectus abdominis musculocutaneous flap harvest: a prospective study.  Ann Plast Surg . 1997;  39 229-234
  • 13 Edsander-Nord A, Jurell G, Wickman M. Donor-site morbidity after pedicled or free TRAM flap surgery: a prospective and objective study.  Plast Reconstr Surg . 1998;  102 1508-1516
  • 14 Edsander-Nord A, Brandberg Y, Wickman M. Quality of life, patients' satisfaction, and aesthetic outcome after pedicled or free TRAM flap breast surgery.  Plast Reconstr Surg . 2001;  107 1142-1155
  • 15 Grotting J C. Immediate breast reconstruction using the free TRAM flap.  Clin Plast Surg . 1994;  21 207-221
  • 16 Feller A. Free TRAM-results and abdominal wall function.  Clin Plast Surg . 1994;  21 223-232
  • 17 Galli A, Adami M, Berrino P, Leone S, Santi P. Long term evaluation of the abdominal wall competence after total and selective harvesting of the rectus abdominis muscle.  Ann Plast Surg . 1992;  28 409-413
  • 18 Duchateau J, Declety A, Lejour M. Innervation of the rectus abdominis muscle: implications for rectus flaps.  Plast Reconstr Surg . 1988;  82 223-227
  • 19 Hammond D C, Larson D L, Severinac R N, Marcias M. Rectus abdominis muscle innervation: implications for TRAM flap elevation.  Plast Reconstr Surg . 1995;  96 105-110
  • 20 Suominen S, Tervahartiala P, von Smitten K, Asko-Seljavaara S. Magnetic resonance imaging of the TRAM flap donor site.  Ann Plast Surg . 1997;  38 23-28
  • 21 Blondeel P N, Vanderstraeten G G, Monstrey S J. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.  Br J Plast Surg . 1997;  50 322-330
  • 22 Futter C M, Webster M HC, Hagen S, Mitchell S L. A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap.  Br J Plast Surg . 2000;  53 578-583
  • 23 Blondeel P N, Boeckx W D, Vanderstraeten G G. The fate of the oblique abdominal muscles after free TRAM flap surgery.  Br J Plast Surg . 1997;  50 315-321
  • 24 Monteiro M. Physical therapy implications following the TRAM procedure.  Phys Ther . 1997;  77 765-770
  • 25 Richardson C A, Jull G A. Muscle control-pain control. What exercises would you prescribe?.  Man Ther . 1995;  1 2-10