An Ultrasound Imaging Evaluation of the Abdominal Wall Muscles Following Breast Reconstruction With Unilateral Pedicled Transverse Rectus Abdominis Myocutaneous (TRAM) Flap

Background

The muscle-sparing (MS) pedicled flap procedure was developed to reduce abdominal morbidities following breast reconstruction with full width pedicled transverse rectus abdominis myocutaneous (TRAM) flap. However, effects of this procedure on muscle morphology of the remnant rectus abdominis (RA) and other abdominal muscles remain unclear.

Objective

This study aimed to evaluate the morphology, by using ultrasound imaging, of the remnant RA and the other abdominal muscles in women with MS pedicled TRAM flap procedure.

Design

A case-control cross-sectional study.

Methods

Thirty-four postmastectomied women with MS unilateral pedicled TRAM flap and 25 age-matched healthy women participated in this study. The curl up test was used to measure the trunk flexor strength. Ultrasonic imaging was performed to measure the thickness of all abdominal wall muscles in all subjects and cross-sectional area (CSA) of RA at rest and during an isometric head-raised position in women with TRAM flap. Acoustic echogenicity and border visibility were used for assessing tissue composition of the remnant RA.

Results

Trunk flexor strength was weaker in women who previously received the TRAM flap procedure than healthy controls (P<.001). The remnant RA in the relaxed state was thinner (P =.001) and its CSA smaller (P = .001) than the contracted state. It was also thinner (P<.001), more echoic and less visible than its contralateral counterpart (both P<.001). No side differences were found in the thickness of other abdominal muscles. Abdominal muscles of the patient group were smaller than healthy controls (P ranged from .001 to .04).

Limitations

The present study is not a prospective longitudinal design. Therefore, a definite cause-effect relation could not be determined from the results of the present study.

Conclusions

In women after unilateral MS pedicled TRAM flap procedure, the remnant RA retains its ability to change in size and thickness during contraction, albeit at a deficient state. Muscular atrophy is not limited to the remnant RA but to other ipsilateral and contralateral abdominal muscles as well. Postoperative immobilization is the most likely cause for such generalized weakness of the abdominal musculatures.

Source: http://ptjournal.apta.org/cgi/content/short/ptj.20120063v1?rss=1

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