Avoiding Denervation of the Rectus Abdominis Muscle in DIEP Flap Harvest III: A Functional Study of the Nerves to the Rectus Using Anesthetic Blockade

Rozen, Warren M.; Tran, Tuyen M. N.; Barrington, Michael J.; Ashton, Mark W.

doi:10.1097/prs.0b013e3181addbee

Cited by 19 publications

(7 citation statements)

References 18 publications

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“…The effect on the strength of the rectus abdominis muscles after administration of a classic TAP block was evaluated as well. 13 However, to our knowledge, the effects on the rest of the abdominal wall muscles after a BD-TAP block (targeting the nerves Th6YL1), and hence possible adverse effects on pulmonary function, have not been subjected to clinical investigations before.…”

Section: Discussionmentioning

confidence: 99%

Is Pulmonary Function Affected by Bilateral Dual Transversus Abdominis Plane Block? A Randomized, Placebo-Controlled, Double-Blind, Crossover Pilot Study in Healthy Male Volunteers

Petersen

Elers

Børglum³

et al. 2011

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 99%

Is Pulmonary Function Affected by Bilateral Dual Transversus Abdominis Plane Block? A Randomized, Placebo-Controlled, Double-Blind, Crossover Pilot Study in Healthy Male Volunteers

Petersen

Elers

Børglum³

et al. 2011

Regional Anesthesia and Pain Medicine

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“…Davies et al described in 1931 the “very free plexus formation” of intercostal nerves in the anterior abdominal wall, 36 and Yap et al reiterated this, describing that “nerves are closely related to the DIEA vascular axis.” 37 Dissection or disruption to the lateral half of a rectus abdominis muscle risks damage to these nerves and creates the potential for rectus muscle denervation. 38–41…”

Section: Discussionmentioning

confidence: 99%

“…37 Dissection or disruption to the lateral half of a rectus abdominis muscle risks damage to these nerves and creates the potential for rectus muscle denervation. [38][39][40][41] As such, despite theoretical donor benefits, the DIEP flap has commonly shown no improvements over musclesparing TRAM flaps, suggesting that rectus muscle continuity may be more important than muscle sacrifice alone. The current technique offers an approach to maintain rectus abdominis continuity after MS1 TRAM flap harvest.…”

Section: Prs Global Open • 2022mentioning

confidence: 99%

The Rectus Abdominis Perforator Turndown Flap for Preserving Rectus Continuity: A DIEP Alternative?

Rozen

Phan

Seifman

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: The deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction has been popularized over the transverse rectus abdominis myocutaneous (TRAM) flap, as it spares rectus abdominis muscle and has low donor site morbidity. This progression to muscle preservation, however, has been associated with an increased difficulty in vascular dissection, perfusion-related complications, and lengthier surgical times. We pilot a technique that may achieve the benefits of the TRAM flap in terms of ease of dissection and vascularity, with the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity. Methods: A cohort of six consecutive patients underwent a free TRAM flap for reconstructive surgery. All patients underwent a segmental, periumbilical harvest of rectus abdominis muscle as part of flap design, and the segmental defect was reconstructed with an innervated rectus abdominis perforator turndown (RAPT) flap harvested supraumbilically. Postoperative assessment of rectus continuity was performed clinically, with muscle electromyography and ultrasound. Results: In all six cases, there was successful TRAM flap transfer, with no flap-related complications. Rectus abdominis muscle reconstruction with the RAPT flap was achieved, with continuity and function of the rectus muscle confirmed. Conclusions: We describe the innervated RAPT flap for reconstitution of rectus continuity after TRAM flap harvest. This technique may achieve the benefits of the TRAM flap in terms of ease of dissection and flap vascularity, and the benefits of the DIEP flap in terms of maintaining rectus abdominis continuity.

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“…To reduce the morbidities after sheath and muscle harvest, the excision must be parallel with the fiber direction of the rectus and limited to the lateral part of muscle. Furthermore, some scholars believe that damage to the intercostal nerve during flap elevation is the main reason for abdominal morbidity rather than damage to the muscle and its fascia 52–55 . Therefore, the intercostal motor nerve, especially the dominant nerve, should be preserved as much as possible 55 .…”

Section: Discussionmentioning

confidence: 99%

Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three‐Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children

Luo

2021

Orthopaedic Surgery

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Objective The aim of the present study was to report a novel design of the chimeric deep inferior epigastric artery perforator flap (DIEP) to achieve dead space filling, Achilles tendon bridging, and skin resurfacing simultaneously with minimal donor‐site morbidity. Methods From September 2012 to May 2016, a retrospective study was carried out on six pediatric patients with composite soft tissue defects of the heel that were repaired with the chimeric DIEP flap. The chimeric flap design included a flap of the anterior sheath of the rectus, a block of rectus muscle, and a large skin paddle. All the parts were supplied by a common artery. After harvesting the flap, all element parts were inserted at the corresponding sites in a tension‐free manner. With one set of vessel anastomoses at the recipient site, accurate repair with tendon reconstruction, dead space elimination, and wound covering were accomplished. The donor site incisions were closed initially. Data on patient age, medical history, injury severity, defect size, flap dimensions, recipient vessels, donor site closure, complications, and follow‐up were collected and reviewed. Results Five of the six chimeric DIEP flaps survived without complications. The remaining one case experienced partial necrosis of the skin paddle caused by venous congestion, which healed after routine dressing changes. Primary donor site closure was accomplished in all cases. The mean follow‐up was 18.6 months (range, 10–36 months). Five patients had satisfactory aesthetic and functional outcomes; one patient needed a secondary debulking procedure. Compared to the unaffected side, the affected side showed no obvious difference for ankle movement, tiptoe function, and patient gait during the follow‐up period. Good ankle function was observed in all patients. There was no donor site breakdown, with only a slightly noticeable linear scar. Conclusion The chimeric DIEP flap reduced the operative time, solved the problem of deficiency of recipient vessels, and attained satisfactory functional and aesthetic outcomes with low donor site morbidity. Therefore, it is a promising option for three‐dimensional reconstruction of composite defects with dead space and Achilles tendon defects as well as skin loss in children.

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Avoiding Denervation of the Rectus Abdominis Muscle in DIEP Flap Harvest III: A Functional Study of the Nerves to the Rectus Using Anesthetic Blockade

Cited by 19 publications

References 18 publications

Is Pulmonary Function Affected by Bilateral Dual Transversus Abdominis Plane Block? A Randomized, Placebo-Controlled, Double-Blind, Crossover Pilot Study in Healthy Male Volunteers

Is Pulmonary Function Affected by Bilateral Dual Transversus Abdominis Plane Block? A Randomized, Placebo-Controlled, Double-Blind, Crossover Pilot Study in Healthy Male Volunteers

The Rectus Abdominis Perforator Turndown Flap for Preserving Rectus Continuity: A DIEP Alternative?

Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three‐Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children

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