TRAM bipediculado com preservação dos músculos retos do abdome abaixo da linha arqueada e sem o uso de tela de reforço

E M Keppke

doi:10.1590/s1983-51752012000100009

Abstract

INTRODUCAO: O emprego de transverse rectus abdominis musculocutaneous (TRAM) bipediculado nas reconstrucoes mamarias tem requerido o uso profilatico de telas no segmento inferior do hipogastrio, pela frequencia de abaulamentos e hernias, a medio e longo prazos. O presente estudo tem o objetivo de registrar um procedimento tecnico utilizado de rotina nas reconstrucoes mamarias com TRAM bipediculado, sem autonomizacao previa, com a preservacao total dos musculos retos e piramidais em suas bainhas no limite da linha arqueada, sem o uso de telas e sem herniacao secundaria da parede abdominal a longo prazo. METODO: Utilizacao, em 11 pacientes, de TRAM bipediculado, sem o uso de telas e sem a presenca de abaulamentos e hernias no segmento inferior do hipogastrio, por meio da preservacao de ambos os musculos retos abdominais, em suas bainhas desde a linha arqueada ate o pubis. A plicatura da parede musculoaponeurotica no hipogastrio seguiu a rotina cirurgica especifica apos a migracao dos musculos retos abdominais, com complementacao da sutura de suas aponeuroses nas respectivas linhas arqueadas, mantendo o reforco necessario para evitar o uso de tela e o aparecimento de abaulamento e hernia. RESULTADOS: O resultado estetico obtido em todos os casos foi considerado satisfatorio pelas pacientes e pela equipe cirurgica. No acompanhamento pos-operatorio, as pacientes nao desenvolveram nenhum tipo de herniacao ou abaulamento secundarios da parede abdominal. CONCLUSOES: A tecnica de TRAM bipediculado com preservacao dos musculos retos do abdome abaixo da linha arqueada e sem o uso de tela de reforco proporciona a obtencao de resultados satisfatorios, mantidos a medio e longo prazos, sem desenvolvimento de nenhum tipo de herniacao secundaria da parede abdominal.

Highlights

Since the pioneering studies, both published in 1982, of Gandolfo[1] and Hartrampf et al.[2] on breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap, the literature has continually recorded contributions by other authors, whose studies have added details that enable improvements in the safety, handling, and aesthetic quality of the results in both the donor and recipient areas
One of the problems referred to in the literature is the presence of herniations and bulging in the hypogastrium, in the middle to long term, in cases where both the rectus muscles are used to prepare the TRAM flap.[12,13]
This study aims to record a technical procedure routi nely used in breast reconstructions: bipedicled TRAM flap without previous autonomization, with total preservation of the rectus and pyramid muscles in their sheaths at the limit of the arcuate line without the use of mesh, and without secondary herniation of the abdominal wall in the long term

Summary

Introduction

Both published in 1982, of Gandolfo[1] and Hartrampf et al.[2] on breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap, the literature has continually recorded contributions by other authors, whose studies have added details that enable improvements in the safety, handling, and aesthetic quality of the results in both the donor and recipient areas. The use of a bipedicled transverse rectus abdominis myocutaneous (TRAM) flap in breast reconstructions has required the prophylactic use of mesh in the lower segment of the hypogastrium, because of the frequency of bulging and herniations in the middle to long term. This study aims to record a technical procedure routinely used in breast recons tructions: bipedicled TRAM flap without previous autonomization, with tot al preservation of the rectus abdominis and pyramidal muscles in their sheaths at the limit of the arcuate line without the use of mesh, and without secondary herniation of the abdominal wall in the long term. Conclusions: The bipedicled TRAM flap technique with preservation of the rectus abdominis muscles below the arcuate line and without the use of reinforcement mesh provides satisfactory results that are maintained in the middle to long term, without the development of any secondary herniation in the abdominal wall

Objectives

Methods

Results

Conclusion