Free or pedicled transverse abdominis musculoperitoneal flap for large duodenal defect

W. Y. Yin, S. M. Huang, Y. H. Hsu, K. Chao, B. W. Tsai, T. W. Chang, P. W. Lin

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Abstract

A large duodenal defect of the second or third portion of duodenum following trauma or even some diseases still requires a standard surgical management. The defect is so large that primary repair is not secure, and resection at this critical portion is technically hazardous or impossible. Serosal or mucosal patch technique has been used to repair such kinds of injury with acceptable outcome, but the procedures are not without drawbacks. Here use of a free or pedicled transverse abdominis musculoperitoneal (TRAMP) flap for repair of the large defect was tried, in search of an ideal technique. A large defect, involving 2-3 cm in length and two thirds of the bowel circumference was created on the second part of duodenum in each of 32 healthy rabbits. In half of them (Group 1), the free TRAMP graft was used to repair the defect, and the pedicled TRAMP taken from anterolateral abdominal wall was utilized in the other half (Group 11). Omentopexy was done in some of the former group. Clinical and histological observations were followed up to 12 weeks. All the animals except one in Group II recovered uneventfully, with an overall mortality rate was 2.8%. None showed leakage or peritonitis. Althongh the free flap was ischemic in the early postoperative period, it could be tolerated very well. Granulation was found after one week. Early revascularization and granulation occurred in the free graft with omentopexy group. The pedicled flap was healthy throughout the course. Reepithelialization, started in two weeks, was complete in six weeks. The free or pedicled TRAMP flap is suggested as another option for repair of large duodenal defect.

Original languageEnglish
Pages (from-to)393-399
Number of pages7
JournalJournal of Surgical Association Republic of China
Volume28
Issue number5
Publication statusPublished - 1995 Dec 1

All Science Journal Classification (ASJC) codes

  • Surgery

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