TRAM - Modified TRAM , DIEP Flap - for Breast reconstruction

THE DEEP INFERIOR EPIGASTRIC ARTERY PERFORATOR (DIEP) & MS -TRAM FLAP

1. RECTUS ABDOMINIS FLAP Dr Shubhanshu Gaurav ASSISTANT PROFESSOR KEM HOSPITAL, MUMBAI

2. BLOOD SUPPLY TYPE – III Pattern 2 Dominant Pedicle – Superior and inferior epigastric artery Dimensions- 25 x 6 cms

3. Arc of rotation 2 standard arc of rotation above and below

4. Coverage Anterior thorax, Posterior trunk Abdomen Groin Vaginal Defects, Scrotal Defects Perineam – APR Defects Breast Reconstruction – Pedicled or as Free Perforator flap H & Neck rec – Free Flap

5. Skin territory Skin island – Directly over the surface of muscle in vertical orientation (VRAM) Or, Transversely across the abdomen (TRAM)

6. TRAM ELEVATION Marking : Skin territory of flap defined below the umbilicus , and above the inguinal ligament, not extending to ASIS.

7. DIEP flap harvest

8. DIEP flap harvest

9. Thank you