The Management of Abdominal Contour Defects Following TRAM Flap Breast Reconstruction

Background In recent decades, biologic mesh (BM) has become an important adjunct to surgical practice. Recent evidence‐based clinical applications of BM include but are not limited to: reconstruction of abdominal wall defects; breast reconstruction; face, head and neck surgery; periodontal surgery; other hernia repairs (diaphragmatic, hiatal/paraesophageal, inguinal and perineal); hand surgery; and shoulder arthroplasty. Prior systematic reviews of BM in complex abdominal wall hernia repair had several shortcomings that our comprehensive review seeks to address, including exclusion of laparoscopic repair, assessment of risk of bias, use of an acceptable meta‐analytic method and review of risk factors identified in multivariable regression analyses. Materials and methods We sought articles of BM for open ventral hernia repair reporting on early complications, late complications or recurrences and included minimum of 50. We used the quality in prognostic studies risk of bias assessment tool. Random effects meta‐analysis was applied. Results This comprehensive review selected 62 articles from 51 studies that included 6,079 patients. Meta‐analytic pooling found that early complications are present in about 50%, surgical site occurrences (SSOs) in 37%, surgical site infections (SSIs) in 18%, reoperation in 7%, readmission in 20% and mortality in 3%. Meta‐analytic estimates of late outcomes included overall complications (42%), SSOs (40%) and SSIs (22%). Specific SSOs included seroma (14%), hematoma (4%), abscess (10%), necrosis (5%), dehiscence (8%) and fistula formation (5%). Reoperation occurred in about 17%, mesh explantation in 9% and recurrence in 36%. Conclusion Estimates of nearly all outcomes from individual studies were highly heterogeneous and sensitivity analyses and meta‐regressions generally failed to explain this heterogeneity. Recurrence is the only outcome for which there are consistent findings for risk factors. Bridge placement of BM is associated with higher risk of recurrence. Prior hernia repair, history of reintervention and history of mesh removal were also risk factors for increased recurrence.

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“…Fifteen studies conducted MVR analysis in an exploratory fashion[64,65,67,70,73,74,82,83,85,86,88,90,93,99,100,103,107,108,113,119,123].…”

mentioning

confidence: 99%

Biologic Mesh in Surgery: A Comprehensive Review and Meta‐Analysis of Selected Outcomes in 51 Studies and 6079 Patients

2021

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“…Other complications, such as incisional hernia, delayed wound healing, incisional infection has never been observed in our study, suggesting the established applicability of omentum. [ 26 – 28 ]…”

Section: Discussionmentioning

confidence: 99%

Immediate breast reconstruction with omental flap for luminal breast cancer patients

Zhi

et al. 2017

Medicine

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Rationale:Luminal subtype breast cancer, accounting for 70 to 80% of all breast cancers, has been reported to be associated with good prognosis. However, for the patients with large mass or worse mass position, omental flap transplantation may provide a new option for breast reconstruction.Patient concerns:Ten patients (6 luminal B1, 2 luminal B2, 2 luminal A), were enrolled into the study, between January 23, 2015 and August 22, 2016. The mean age was 34.6 ± 6.96 (24-44) years old. Immunohistochemistry demonstrated that the tumor cells were positive for estrogen receptor and progestrone receptor.Diagnoses:According to the clinicopathological features, diagnosis of breast cancer patients were made.Interventions:Breast-conserving surgery, laparoscopic greater omentum harvest and vascular anas-tomosis were carried out orderly. Postoperative operative results, cosmetic outcomes, complications, as well as blood supply were investigated for surgery evaluation. Reasonable chemotherapy and irradia-tion were adopted to patients according to the pathological condition.Outcomes:We successfully accomplished breast reconstruction by omental flap transplantation, ex-cept one failed case because of the necrosis of omentum and changed to fat transplantation. The volumes and symmetry of breasts were all satisfied. The blood supply was detected to be fluent. Only one case of slight hematoma and another case of one distant metastasis were observed during fol-low-up period. No arm mordities or arm movement restriction occurred after surgery. Moreover, radia-tion therapy and chemotherapy had no clear effects on the reconstructed breast.Lessons:Immediate breast reconstruction surgery by transplanting omental flap for luminal breast cancer patients can be considered successful based on the excellent clinic outcome.

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“…The basis of this model was inspired by the observation in clinical practice that hernia or abdominal weakness developed in patients who had their rectus abdominis muscle harvested for flap surgery. [39][40][41] There were three unique features of this developed model. First, there was a focus on the evaluation of changes to the implant area (e.g.…”

Section: Discussionmentioning

confidence: 99%

A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

et al. 2016

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An animal model that allows for assessment of the degree of stretching or contraction of the implant area and the in vivo degradation properties of biological meshes is required to evaluate their performance in vivo. Adult New Zealand rabbits underwent full thickness subtotal unilateral rectus abdominis muscle excision and were reconstructed with the non-biodegradable Peri-Guard®, Prolene® or biodegradable Surgisis® meshes. Following 8 weeks of recovery, the anterior abdominal wall tissue samples were collected for measurement of the implant dimensions. The Peri-Guard and Prolene meshes showed a slight and obvious shrinkage, respectively, whereas the Surgisis mesh showed stretching, resulting in hernia formation. Surgisis meshes showed in vivo biodegradation and increased collagen formation. This surgical rabbit model for abdominal wall defects is advantageous for evaluating the in vivo behaviour of surgical meshes. Implant area stretching and shrinkage were detected corresponding to mesh properties, and histological analysis and stereological methods supported these findings.

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The Management of Abdominal Contour Defects Following TRAM Flap Breast Reconstruction

Abstract: Incisional hernia following TRAM flap breast reconstruction can be a challenging problem. Attention to surgical technique and the use of mesh minimize the risk of recurrence.

Cited by 12 publications

References 24 publications

Biologic Mesh in Surgery: A Comprehensive Review and Meta‐Analysis of Selected Outcomes in 51 Studies and 6079 Patients

Biologic Mesh in Surgery: A Comprehensive Review and Meta‐Analysis of Selected Outcomes in 51 Studies and 6079 Patients

Immediate breast reconstruction with omental flap for luminal breast cancer patients

A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

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