%0 Journal Article
%T New technical approach for the repair of an abdominal wall defect after a transverse rectus abdominis myocutaneous flap: a case report
%A Daniel A Kaemmer
%A Joachim Conze
%A Jens Otto
%A Volker Schumpelick
%J Journal of Medical Case Reports
%D 2008
%I BioMed Central
%R 10.1186/1752-1947-2-108
%X We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap (TRAM-flap) breast reconstruction. The surgery led to the patient developing an enormous abdominal bulge that caused her disability in terms of abdominal wall and bowel function, pain and contour. In the absence of rectus muscle, the large defect was repaired using a combination of the abdominal wall component separation technique of Ramirez et al and additional mesh augmentation with a lightweight, large-pore polypropylene mesh (Ultrapro£¿).The procedure of Ramirez et al is helpful in achieving a tension-free closure of large defects in the anterior abdominal wall. The additional mesh augmentation allows reinforcement of the thinned lateral abdominal wall.Abnormalities of the abdominal wall contour after breast reconstruction with autologous tissue transfer have previously been reported as problematic, with a lower abdominal bulge being the most frequently reported abnormality [1]. Although the cosmetic results and patient satisfaction seem to be good in most cases with regards to shape, symmetry and muscular function, differences become obvious in the morbidity of the donor site [2-5]. Modifications and new techniques have been developed to reduce complications, but none of these modifications is able to prevent contour abnormalities of the donor site completely [6], and new techniques, which preserve the anterior rectus sheath are limited in their use by anatomic variations [2].In addition to the aesthetic disturbance, these defects can also lead to adverse interference of the abdominal wall functions, as a thrust bearing for the intraabdominal pressure and as an antagonist of the back muscles and part of the respiratory system. To date, these side effects have not attracted attention in the literature and no therapeutic approaches have been reported.Here we present the case of a woman with an extreme bulge of the lower abdominal wall following bilateral transverse rectus
%U http://www.jmedicalcasereports.com/content/2/1/108