Skip to main content

Advertisement

SpringerLink
Log in

The extraperitoneal laparoscopic TRAM flap delay procedure: an alternative approach

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Ligation of the deep inferior epigastric vessels prior to transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction (delay procedure) was introduced to augment vascularity to the island flap through improved superior epigastric flow, thus decreasing flap morbidity. There are various surgical approaches described, including open and laparoscopic approaches, for ligation of inferior epigastric arteries. We describe an extraperitoneal laparoscopic technique (EPLT) and the outcomes of the procedure.

Methods

All patients who underwent EPLT prior to TRAM flap construction between July 2006 and December 2008 were included in the study. Data were analyzed retrospectively from a prospectively collected database.

Results

The study group included 11 female patients with mean age of 55 years and mean body mass index (BMI) of 34.4 kg/m2. There were no conversions to open procedure. Ten patients had bilateral ligation of inferior epigastric arteries, and one patient had it only on one side. There were no complications related to the procedure.

Conclusion

Extraperitoneal laparoscopic technique as a delay procedure for TRAM flap reconstruction is safe and feasible with no morbidity related to surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69(2):216–225

    Article  PubMed  CAS  Google Scholar 

  2. Codner MA, Bostwick J 3rd, Nahai F, Bried JT, Eaves FF (1995) TRAM flap vascular delay for high-risk breast reconstruction. Plast Reconstr Surg 96(7):1615–1622

    Article  PubMed  CAS  Google Scholar 

  3. Erdmann D et al (2002) Delay in unpedicled TRAM flap reconstruction of the breast: a review of 76 consecutive cases. Plast Reconstr Surg 119(3):762–767

    Article  Google Scholar 

  4. Jensen JA (2003) TRAM flap delay: two techniques and an unresolved question. Plast Reconstr Surg 111(7):2478–2479

    Article  PubMed  Google Scholar 

  5. Lam TC, Sellars GD (2003) Free perforator crossover TRAM flap for breast reconstruction. Ann Plast Surg 50(2):126–131

    Article  PubMed  Google Scholar 

  6. Temple CL, Strom EA, Youssef A, Langstein HN (2005) Choice of recipient vessels in delayed TRAM flap breast reconstruction after radiotherapy. Plast Reconstr Surg 115(1):105–113

    PubMed  CAS  Google Scholar 

  7. Wang HT, Hartzell T, Olbrich KC, Erdmann D, Georgiade GS (2005) Delay of transverse rectus abdominis myocutaneous flap reconstruction improves flap reliability in the obese patient. Plast Reconstr Surg 116(2):613–618

    Article  PubMed  CAS  Google Scholar 

  8. Yuksel F, Celikoz B (2002) Double-pedicled TRAM flap breast reconstruction: following Bostwick’s principles. Aesth Plast Surg 26:444–450

    Article  Google Scholar 

  9. Gabbay JS, Eby JB, Kulber DA (2005) The midabdominal TRAM flap for breast reconstruction in morbidly obese patients. Plast Reconstr Surg 115(3):764–770

    Article  PubMed  CAS  Google Scholar 

  10. Liem MSL, van Vroonhoven TJMV (1996) Review. Laparoscopic inguinal hernia repair. Br J Surg 83:1197–1204

    Article  PubMed  CAS  Google Scholar 

  11. Dulucq JL, Wintringer P, Mahajna A (2009) Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3, 100 hernia repairs over 15 years. Surg Endosc 23(3):482–486

    Article  PubMed  Google Scholar 

  12. Ebrahimi A, Cosman P, Widdowson P, Crampton N (2005) TRAM flap delay: An extaperitoneal laparoscopic technique. ANZ J Surg 75:911–913

    Article  PubMed  Google Scholar 

  13. Restifo RJ, Ahmed SS, Rosser J et al (1998) TRAM flap perforator ligation and the delay phenomenon: development of an endoscopic/laparoscopic delay procedure. Plast Reconstr Surg 101(6):1503–1511

    Article  PubMed  CAS  Google Scholar 

  14. Trus TL, Collins ED, Demas C, Kerrigan C (2007) Initial experience with laparoscopic inferior epigastric vessel ligation for delayed transverse rectus abdominus musculocutaneous flap breast reconstruction. Arch Surg 142:362–364

    Article  PubMed  Google Scholar 

  15. Kaddoura IL, Khoury GS (1998) Laparoscopic transverse rectus abdominus flap delay for autogenous breast reconstruction. JSLS 2:63–65

    PubMed  CAS  Google Scholar 

  16. Bowne WB, Morgenthal CB et al (2007) The role of endoscopic extraperitoneal herniorrhaphy: where do we stand in 2005? Surg Endosc 21(5):707–712

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

Panduranga Yenumula, Erick F. Rivas, Keith M. Cavaness, Ed Kang, and Edward Lanigan have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Michigan State University, 1200 E. Michigan Avenue Suite 655, Lansing, MI, 48912, USA

    Panduranga Yenumula, Erick F. Rivas, Keith M. Cavaness, Ed Kang & Edward Lanigan

Authors
  1. Panduranga Yenumula
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erick F. Rivas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keith M. Cavaness
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ed Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edward Lanigan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Panduranga Yenumula.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yenumula, P., Rivas, E.F., Cavaness, K.M. et al. The extraperitoneal laparoscopic TRAM flap delay procedure: an alternative approach. Surg Endosc 25, 902–905 (2011). https://doi.org/10.1007/s00464-010-1294-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1294-5

Keywords

Search

Navigation