Clinical and ultrasound evaluation of donor site morbidity after tram-flap for breast reconstruction

• Published in: Microsurgery 2004, Vol.24 (3), p.174-181
• Main Authors: Benditte-Klepetko, Heike, Sommer, O., Steinbach, R., Czembirek, H., Deutinger, M.
• Format: Article
• Language: English
• Subjects: Abdominal Muscles - diagnostic imaging; Abdominal Muscles - transplantation; Adult; Biological and medical sciences; Case-Control Studies; Combined surgery. Multiple transplantations; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Mammaplasty - adverse effects; Mammaplasty - methods; Medical sciences; Middle Aged; Muscle Contraction - physiology; Probability; Reference Values; Risk Assessment; Sampling Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Tissue and Organ Harvesting; Ultrasonography, Doppler; Wound Healing - physiology
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.20044

The TRAM‐flap has become a well‐established method for breast reconstruction. Even though the aesthetic result is superior to implant reconstruction, a main disadvantage is the potential risk to create weakness of the abdominal wall. For evaluation of abdominal wall function, an imaging method has to be used which is able to prove functional properties of the remaining muscle. This study was undertaken in order to verify if ultrasound imaging is a reasonable method to examine muscle movements after TRAM‐flap procedures in addition to clinical examination. In 8 patients, a DIEP‐flap, in 11 patients, a free TRAM‐flap, and in 3 patients, a pedicled TRAM‐flap were used for breast reconstruction. Patients were examined 10–72 months (mean, 32 months) after surgery. Ultrasound imaging of the abdominal wall was performed in longitudinal as well as cross sections (multifrequent, 13 Mhz; Siemens Elegra, Erlangen, Germany). The diameter of the remaining muscle was measured 2 cm below the rib bow, at the level of the umbilicus, and at the level of the skin scar. The operated side was compared to the nonoperated contralateral side. In order to evaluate the contractility of the remaining rectus muscle, patients were invited to perform sit‐ups during ultrasound monitoring of muscle movement. Clinically the functional testing was performed by the method of Janda (Muskelfunktionsdiagnostik, 2nd ed. Berlin: Volk‐ und Gesundheit; 1986). The abdominal wall was inspected for bulging or hernia formation. Additionally, patients answered a six‐scale self‐designed questionnaire concerning the impairment of daily living and pain. Muscle contractility as well as muscle diameter were graded into four degrees from 0–3. The highest degree of 3 with normal muscle contractility and muscle diameter was found in 1 of 5 patients after DIEP‐flap. Degree 2, with reduced muscle contractility and reduced muscle diameter, was found in 10 of 22 patients, especially after unilateral TRAM‐flap. Degree 1, with no muscle contractility and remaining muscle, and degree 0, with scar tissue, were found in 11 patients. Impairment in daily‐life activity was found in 10 patients, while 8 patients complained of pain. Muscle strength scored by the method of Janda (Muskelfunktionsdiagnostik, 2nd ed. Berlin: Volk‐ und Gesundheit; 1986) reached 4 and 5 in 19 patients after all kinds of flap harvesting; 3 patients reached Janda 2 and 3 after unilateral free TRAM or unilateral DIEP‐flap. In one patient, a hernia w