TRAM
The rectus abdominis muscle is mathes and nahai type
III
Pedicled Lattisimus flap complications are all related to the
Donor site
Seroma, wound dehisence, scar widening, etc
Through the greater sciatic foramen just under the subgluteal fat bad, several large branches o the SGA exist. Some surgeon's refer to this region as
Medusa's head - due to number of branches & risk of following the wrong vessel
The gracillis flap was frst used for what reconstruction in 1952
Rectal sphincter :)
35%
Pedicled TRAM relies on this vascular pedicle
This branch of the thoracodorsal artery gives off the most reliable perforators
Lateral branch
The main perforator of the superior gluteal a can be found by palpating this sructure
Greater sciatic foramen
Name two other muscles that share the Mathes and Nahai type of gracilis
Temporalis
Trapezius
Soleus
SCM
Vasctus lateralis
Biceps femoris
Peroneus longus/brevis
ABdm
AB halluces
Semitendonosus
This type of breast cancer makes reconstruction challenging 2/2 diffuse skin and lymphatic involvement as well as the need for radiation. Some surgeons consider this a contraindication to reconstruction.
Inflammatory breast cancer
Contraindication to pedicled TRAM
Injury to SEA (ie: open chole)
Name another muscle that shares Mathes and Nahai type with Latissimus
Pec major
Name two disadvanages of using gluteal flaps for breast recon
Dissection difficulties
Pedicle length and caliber
Vessel mismatch
Lower success rate than DIEP
Longer operative time
What is the key principle of molding the TUG flap
Must be molded into some variation of a CONE for shape
Name some indications for NSM
Small breasts
unifocal disease >2cm away from NAC
Tumor size <2-5cm
Low grade
HER2 negative, ER PR positive
Compared to DIEP, free TRAM has increased risk of
Hernia/abdominal bulge
Where does the lattisimus insert onto
Intertubucular groove of humerus
Name two advantages of using gluteal flap
No risk of hernia
Sufficient tissue even in thin patients
Hidden donor site scar (especially IGAP)
Describe the typical ideal patient for a TUG flap
Patent with small breasts and no abdominal donor site
This type of incision in NSM causes a high incidence of nipple necrosis
Periareolar
Name two recipient vessels for free flap breast recon
Internal mammary perforators
Thoracodorsal
Lattisimus has latin origins "latus dorsum" ... what does this mean in latin
The broadest muscle in the back
This is a local alternative for venous outflow if thoracodorsal and internal mammaries are unavailable
Cephalic vein turndown
Describe disadvantages of using TUG flap
Scar visibility
Potential for lymphedema
Low volume of tissue
True or false: Neoadjuvant chemo does not have an increased incidence of infection, recon falure, & return to OR
TRUE