Abstract
The transverse rectus abdominis myocutaneous (TRAM) flap is one of the techniques for breast reconstruction surgery and other defects. Assuring the vascular input is the main factor that it should be ensured for the survival of the fap. Objective: The article presented is an experimental study, with the objective of evaluating the effect of the vasculature on the myocutaneous flaps of the abdominal rectum with botulinum toxin type A (TBoA) thay may improve the survival of the tissue by promoting the blood perfusion in distal parts of the flap and diminish the risk of necrosis. Material and methods: A total of 30 Wistar male rats, dissect pedicled right TRAM flap in all rats, divided into three groups: Group 1 was applied in saline solution 0.9%; Group 2 was applied in pre surgically TBoA (1 week before lifting the flap); Group 3, will apply TBOA Trans surgical. Results: Histological analysis showed: increased vascularity in group 2 TBoA compared with the saline solution with P < 0.05 statistically significant. In terms of fibrosis, inflammation and granulation tissue, there was no statistically significant difference at p = 0.6. Muscle atrophy was higher in the group of TBoA in the saline group p < 0.05. It was concluded that botulinum toxin type A prevents vasoconstriction of the vessel and promotes vasodilation subsequently lifting the muscle flap, no complications were observed in the groups with TBoA so it can be considered a safe substace and can be used for further studies.
Highlights
The transverse rectus abdominis myocutaneous (TRAM) flap (Transverse Rectus abdominis myocutaneous) still remains a very useful and popular method of breast reconstruction [1]
Being the group of saline solution 0.9% (Group 1) the one suffering more percentage of necrosis and the group of transsurgical botulinum toxin the one suffering the lowest percentage of necrosis
Histological results: Samples of healthy rats abdominal wall, was denominated as Control 0. This sample was taken as the baseline measurement to perform comparative analysis between the 3 groups with TRAM flap: Group 1: 0.9% saline solution, group 2: Presurgical TBoA, group 3: trans surgical TBoA. against the group of pre surgical TBoA 11.9 ± 2.5 p < 0.05 and against trans-surgical TBoA 7% ± 3.1% p < 0.05 was found
Summary
The TRAM flap (Transverse Rectus abdominis myocutaneous) still remains a very useful and popular method of breast reconstruction [1] Performing it in conventional manner, with pedicle, has a relatively high incidence of complications, from which fat necrosis is the most common [2]. To reduce the rate of complications, especially in high risk patients, the surgical delay of the flap linking one of its vascular pedicles, the deep epigastric inferior artery [4], cutting the skin territory randomly was considered for a while [1]. Later, it was abandoned by the introduction of variations to the conventional technique. Performing the transfer of TRAM as a free flap using its dominant pedicle and/or super-charging the flap with a second vascular source by means of a microvascular anastomosis, is another method well described to enhance survival of the skin island, this technique requires a plastic surgeon with training and experience in microsurgery [6]
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