WORLD JOURNAL OF PLASTIC SURGERY
مجله جهانی جراحی پلاستیک
WJPS
Medical Sciences
http://wjps.ir
1
admin
2228-7914
2252-0724
8
10.61186/wjps
14
8888
13
en
jalali
1396
1
1
gregorian
2017
4
1
6
2
online
1
fulltext
en
Comparative Perfusion Analysis of Free Muscle-Sparing Versus Pedicle Transverse Rectus Abdominis Myocutaneous (TRAM) Flaps in Vivo in the Peri-Operative and Late Post-Operative Periods
عمومى
General
مقالات اصيل
Original Article
<p><strong>BACKGROUND</strong></p>
<p>Current teaching suggests increased perfusion in free transverse rectus abdominis myocutaneous (TRAM) flaps over pedicled TRAM flaps, broadening indications for its use in high risk patients. This study compared perfusion analysis of free muscle-sparing versus pedicle TRAM flaps <em>in vivo</em> in the peri-operative and late post-operative periods.</p>
<p><strong>METHODS</strong></p>
<p>The SPY-Elite system using indocyanine green dye was used to analyze flap perfusion intra-operatively and at 1 week and 3 months post-operatively. Image analysis was completed by evaluating the perfusion maps from the SPY- Elite system with Image J software calculate maximum, minimum, and average luminescence over the surface area of the flaps. Student’s T-test was used for statistical analysis.</p>
<p><strong>RESULTS</strong></p>
<p>Intra-operatively, we found a 73.4% greater perfusion in the free muscle-sparing as compared to the pedicled TRAM. This increase in free muscle-sparing TRAM perfusion was not evident 1 week post-operatively, due to a relative increase in pedicle flap perfusion that coincided with a revision of the pedicled flap due to distal flap necrosis. At 3 months, the free muscle-sparing TRAM flap once again showed superior perfusion with a 15.7% increase over the pedicled flap.</p>
<p><strong>CONCLUSION</strong></p>
<p>We showed superior free muscle-sparing TRAM perfusion in the early peri-operative period which coincided with the time framein which flap loss was most common. Local swelling, pedicle rotation, tunneling, and dominance of the deep inferior epigastric circulation were potential causes of initial decreased pedicled TRAM perfusion. This analysis adds more objective data to the question of indications and relative strengths between free and pedicled TRAM flaps.</p>
fssS
Perfusion, Free muscle-sparing, Pedicle transverse rectus abdominis myocutaneous, Flap, TRAM
144
151
http://wjps.ir/browse.php?a_code=A-10-252-1&slc_lang=en&sid=1
Richard
McNally
rmcnally@uci.edu
10031947532846003560
10031947532846003560
Yes
Department of Plastic Surgery, University California Irvine, 200 South Manchester Ave. Suite 650, Orange CA 92868, USA
Jonathan
Rimler
jrimler@uci.edu
10031947532846003561
10031947532846003561
No
Department of Plastic Surgery, University California Irvine, 200 South Manchester Ave. Suite 650, Orange CA 92868, USA
Vincent
Laurence
vincent.g.laurence@gmail.com
10031947532846003562
10031947532846003562
No
Department of Plastic Surgery, University California Irvine, 200 South Manchester Ave. Suite 650, Orange CA 92868, USA
Keyianoosh
Paydar
kpaydar@uci.edu
10031947532846003563
10031947532846003563
No
Department of Plastic Surgery, University California Irvine, 200 South Manchester Ave. Suite 650, Orange CA 92868, USA; Denotes Co-Senior Authorship
Garrett
Wirth
gwirth@uci.edu
10031947532846003564
10031947532846003564
No
Department of Plastic Surgery, University California Irvine, 200 South Manchester Ave. Suite 650, Orange CA 92868, USA; Denotes Co-Senior Authorship