Autologous Recon

TRAM

100

The rectus abdominis muscle is mathes and nahai type

III

200

Pedicled TRAM relies on this vascular pedicle 

Superior epigastric artery

300

Contraindication to pedicled TRAM

Injury to SEA (ie: open chole)

400

Compared to DIEP, free TRAM has increased risk of

Hernia/abdominal bulge

500

Name two recipient vessels for free flap breast recon

Internal mammary perforators

Thoracodorsal

Lat

100

Pedicled Lattisimus flap complications are all related to the

Donor site

Seroma, wound dehisence, scar widening, etc

200

This branch of the thoracodorsal artery gives off the most reliable perforators

Lateral branch

300

Name another muscle that shares Mathes and Nahai type with Latissimus

Pec major

400

Where does the lattisimus insert onto

Intertubucular groove of humerus

500

Lattisimus has latin origins "latus dorsum" ... what does this mean in latin

The broadest muscle in the back

Glut

100

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

200

The main perforator of the superior gluteal a can be found by palpating this sructure

Greater sciatic foramen

300

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

400

Name two advantages of using gluteal flap

No risk of hernia

Sufficient tissue even in thin patients 

Hidden donor site scar (especially IGAP)

500

This is a local alternative for venous outflow if thoracodorsal and internal mammaries are unavailable

Cephalic vein turndown

TUG flap - transverse upper gracilis

100

The gracillis flap was frst used for what reconstruction in 1952

Rectal sphincter :)

200

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

300

What is the key principle of molding the TUG flap

Must be molded into some variation of a CONE for shape

400

Describe the typical ideal patient for a TUG flap

Patent with small breasts and no abdominal donor site

500

Describe disadvantages of using TUG flap

Scar visibility

Potential for lymphedema

Low volume of tissue

Misc

100

What percent of women treated for breast cancer receive immediate recon?

35%

200

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

300

Name some indications for NSM

Small breasts

unifocal disease >2cm away from NAC

Tumor size <2-5cm

Low grade

HER2 negative, ER PR positive

400

This type of incision in NSM causes a high incidence of nipple necrosis

Periareolar

500

True or false: Neoadjuvant chemo does not have an increased incidence of infection, recon falure, & return to OR

TRUE