Assessment of the abdominal wall function after pedicled XXXX flap surgery for breast reconstruction: Use of modified mesh repair for the donor defect.

@entity1 @entity154 @entity5 @entity20231 @entity547 @entity1521
BACKGROUND: The pedicled @entity20231 flap has been a workhorse of autologous breast reconstruction for decades. However, there has been a rising concern about the abdominal wall donor site morbidity with the use of conventional @entity20231 flap. This has generally been cited as one of the main reasons for resorting to "abdominal wall friendly" techniques. This study has been undertaken to assess the abdominal wall function in @entity1 with pedicled @entity20231 flap breast reconstruction. The entire width of the muscle and the overlying wide disk of anterior rectus sheath were harvested with the @entity20231 flap in all our @entity1 and the anterior rectus sheath defect was repaired by a @entity1521 mesh. MATERIALS AND METHODS: Abdominal wall function was studied in 21 @entity1 who underwent simultaneous primary unipedicled @entity20231 flap reconstruction after mastectomy for @entity5 . In all the @entity1 , the abdominal wall defect was repaired using wide sheet of @entity1521 mesh both as inlay and onlay. The assessment tools included straight and rotational curl ups and a subjective questionnaire. The abdominal wall was also examined for any asymmetry, bulge, or @entity547 . The minimal follow-up was 6 months postoperative. The objective results were compared with normal unoperated volunteers. RESULTS AND CONCLUSIONS: The harvesting the @entity20231 flap certainly results in changes to the anterior abdominal wall that can express themselves to a variable degree. A relatively high incidence of asymptomatic asymmetry of the abdomen was seen. There was total absence of @entity547 in our series even after a mean follow-up period of 15.5 months. A few @entity1 were only able to partially initiate the sit up movement and suffered an important loss of strength. In most @entity1 , synergists took over the functional movement but as the load increased, flexion and rotation performances decreased. The lack of correlation between exercise tests and the results of the questionnaire suggests that this statistically significant impairment was functionally not important. The @entity1 encountered little or no difficulty in theis day-to-day activities. Our modification of use of a wide mesh as inlay and onlay repair minimizes the donor site morbidity. This also avoids maneuvers meant for primary closure of the @entity154 , which can result in distortion of umbilicus. Therefore, in conclusion, the unipedicled @entity20231 flap should be regarded as a valuable option in breast reconstruction provided careful repair of the abdominal wall defect is undertaken using @entity1521 mesh.
