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The Transverse Rectus Abdominus Myocutaneous (Tram) Flap

The document describes the anatomy and surgical technique of a transverse rectus abdominis myocutaneous (TRAM) flap. Key details include: - The TRAM flap involves skin, fascia, and the rectus abdominis muscle. It is supplied by the deep inferior epigastric artery and paired veins. - The surgical technique involves elevating the flap above the rectus fascia to identify perforators, then incising the fascia longitudinally to encompass the perforators. The rectus muscle can be transected to fully elevate the flap. - A history of pedicled flap procedures is provided, with the TRAM flap technique originating in the 1940s.

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42 views

The Transverse Rectus Abdominus Myocutaneous (Tram) Flap

The document describes the anatomy and surgical technique of a transverse rectus abdominis myocutaneous (TRAM) flap. Key details include: - The TRAM flap involves skin, fascia, and the rectus abdominis muscle. It is supplied by the deep inferior epigastric artery and paired veins. - The surgical technique involves elevating the flap above the rectus fascia to identify perforators, then incising the fascia longitudinally to encompass the perforators. The rectus muscle can be transected to fully elevate the flap. - A history of pedicled flap procedures is provided, with the TRAM flap technique originating in the 1940s.

Uploaded by

yahya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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THE TRANSVERSE RECTUS ABDOMINUS

MYOCUTANEOUS (TRAM) FLAP


ANATOMIC CONSIDERATIONS

• Tissue:A skin, fascia and muscle flap.Innervation:Intercostal


nerves, not typically harvested as a sensory flap.Blood
supply:The deep inferior epigastric artery and venae
originating on the external iliac vessels just above the
inguinal ligament.Artery:Large caliber artery from 2 to 4
millimeters.Vein(s):The venae are typically paired, common
to a common vessel at their draining point on the external
iliac. One vein is usually larger and comparable in caliber to
the artery.Pedicle length:This depends on muscle entry and
the amount of intramuscular dissection performed. Five to
7 centimeters can be obtained easily.
• The flap is elevated superficial to the rectus
fascia until major perforators over the rectus
muscle are identified.
• The rectus fascia is incised longitudinally and
the to encompass the lateral extent of the
major perforators.
• The contralateral flap is elevated and a medial
perforator identified and spared.
• The fascia is incised medial to the medial
perforators. The lateral and medial extent of
fascia incision and removal are now identified.
• The superior fascia is incised. The upper edge
of the rectus muscle can be transected and the
flap can be elevated from superior to inferior.
• the inferior fascia is incised and the inferior
muscle can be transected, taking care not the
injure the deep inferior epigastric vessels.
• the flap is isolated, leaving a fascial defect.
Depending on the size of the defect, it can be
repaired primarily or reinforced with mesh.
HISTORY
• 1895 Vincent Czerny  transplantation of a
large lipoma from the patient’s flank
•  1906 the Tanzini  a pedicled flap of skin
and underlying latissimus dorsi muscle 
• 1905 Ombredanne  pectoral muscle as
amound.  luxury operation 
• 1942 Sir Harold Gilles  tubed abdominal flap
method
• TRAM mouse 1.pdf

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