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How is Post- TRAM Bulge Different Than Incisional Ventral Hernia . A Literature Review and our experience.
Moheb S Said.
Douglas S Wagner
Summa Health Care Plastic Surgery Program
2017-02-14
Presenter: Moheb S Said
Affidavit:
This abstract has not been published in any scientific journal or previously presented at a major meeting. Material was discussed and approved by the Program Director, Dr. Douglas S Wagner
Director Name: Douglas S Wagner
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
TRAM flap has been the work horse of autologous breast reconstruction since the 1980s. Avoiding donor site morbidity (Bulge/Hernia), was the impetus for the progression from the pedicled TRAM to the Free TRAM and the DIEP flap
According to Nahabedian et al, Abdominal bulge is defined as abdominal wall laxity without an associated fascial defect. Hernia is defined as abdominal wall laxity with an associated fascial defect.
Based on the above definition,
Abdominal wall bulge was referred to as a functional problem rather than a true defect .
Material and Method:
We conducted a PUBMED search in an attempt to answer the following questions, 1- Is an abdominal wall bulge a functional or a true anatomical hernia, 2- Clinical and Radiological difference between a bulge and a hernia, 3-How to prevent and repair a bulge
Conclusion:
Based on the available literature, and current management of abdominal wall bulge compared to our practice we agree with Kroll et al that abdominal wall bulge is a facial defect (true hernia), but not just involving the internal oblique fascia, rather involving a defect in the internal oblique / transverses abdomens complex, resulting in overstretching and weakness of the transversals fascia through which the peritoneum herniates. Proper prevention and management should pay attention to the anatomical reconstruction of the internal oblique/ transverses tendon sheath complex.
Key words: TRAM, Abdominal Bulge, Abdominal wall weakness, ventral hernia, Incisional hernia, Breast reconstruction.
