Using Of The GIA 80 Reloadable Stapler In Tram Flaps

摘要

Sir:Breast reconstruction using the transverse rectus abdominis myocutaneous flap (TRAM) has been a popular option since its introduction in 1982 [1]. This flap is commonly performed as a pedicled flap based on the superior epigastric system or as a free flap based on the inferior epigastric system. During the dissection of the rectus abdominis muscle, either the upper and/or lower portion of the muscle needs to be divided.Often, the rectus muscle is divided by cautery or knife with suture. This can either result in bleeding or significant movement by the muscle during division.We apply a simple technique to prevent such a complication by using a stapler device for cutting and controlling bleeding in the rectus muscle. We have found only two publications about dividing of the rectus abdominis muscle by stapler device [2, 3].This technique has not been reported for use in breast reconstruction.Since 2004 we use Reloadable Stapler GIA 80 (Auto Suture ?, United States Surgical, Tyco Health Care Group) with 4.8 mm staples for cutting and suturing of the caudal part of the rectus abdominis muscle. After incision of anterior rectal sheath from both sites above the rectus abdominis muscle we separate the muscle from the posterior rectal sheath in its inferior portion. We apply an anvil fork of the GIA 80 under the muscle; apply a cartridge fork of the device and cut the muscle (fig. 1).