{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:29:01Z","timestamp":1746145741377},"reference-count":14,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2004,4,21]],"date-time":"2004-04-21T00:00:00Z","timestamp":1082505600000},"content-version":"vor","delay-in-days":111,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2004,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The TRAM\u2010flap has become a well\u2010established method for breast reconstruction. Even though the aesthetic result is superior to implant reconstruction, a main disadvantage is the potential risk to create weakness of the abdominal wall. For evaluation of abdominal wall function, an imaging method has to be used which is able to prove functional properties of the remaining muscle. This study was undertaken in order to verify if ultrasound imaging is a reasonable method to examine muscle movements after TRAM\u2010flap procedures in addition to clinical examination. In 8 patients, a DIEP\u2010flap, in 11 patients, a free TRAM\u2010flap, and in 3 patients, a pedicled TRAM\u2010flap were used for breast reconstruction. Patients were examined 10\u201372 months (mean, 32 months) after surgery. Ultrasound imaging of the abdominal wall was performed in longitudinal as well as cross sections (multifrequent, 13 Mhz; Siemens Elegra, Erlangen, Germany). The diameter of the remaining muscle was measured 2 cm below the rib bow, at the level of the umbilicus, and at the level of the skin scar. The operated side was compared to the nonoperated contralateral side. In order to evaluate the contractility of the remaining rectus muscle, patients were invited to perform sit\u2010ups during ultrasound monitoring of muscle movement. Clinically the functional testing was performed by the method of Janda (Muskelfunktionsdiagnostik, 2nd ed. Berlin: Volk\u2010 und Gesundheit; 1986). The abdominal wall was inspected for bulging or hernia formation. Additionally, patients answered a six\u2010scale self\u2010designed questionnaire concerning the impairment of daily living and pain. Muscle contractility as well as muscle diameter were graded into four degrees from 0\u20133. The highest degree of 3 with normal muscle contractility and muscle diameter was found in 1 of 5 patients after DIEP\u2010flap. Degree 2, with reduced muscle contractility and reduced muscle diameter, was found in 10 of 22 patients, especially after unilateral TRAM\u2010flap. Degree 1, with no muscle contractility and remaining muscle, and degree 0, with scar tissue, were found in 11 patients. Impairment in daily\u2010life activity was found in 10 patients, while 8 patients complained of pain. Muscle strength scored by the method of Janda (Muskelfunktionsdiagnostik, 2nd ed. Berlin: Volk\u2010 und Gesundheit; 1986) reached 4 and 5 in 19 patients after all kinds of flap harvesting; 3 patients reached Janda 2 and 3 after unilateral free TRAM or unilateral DIEP\u2010flap. In one patient, a hernia was detected after unilateral DIEP\u2010flap; 10 patients showed bulging of the abdominal wall. Functional testing of the abdominal wall by the method of Janda as well as CT\u2010scans or MRI for evaluation of the remaining muscle is reported in the literature. As there is a need for cost reduction in medical treatment, we were looking for a more cost\u2010effective evaluation method compared to CT\u2010scan or MRI. Ultrasound imaging of the donor site after TRAM\u2010flap harvesting in order to evaluate the remaining function of the rectus muscle is not yet reported in the literature. We consider ultrasound imaging to be superior to CT\u2010scan or MRI in terms of functional evaluation and cost effectiveness. \u00a9 2004 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/micr.20044","type":"journal-article","created":{"date-parts":[[2004,4,21]],"date-time":"2004-04-21T15:01:05Z","timestamp":1082559665000},"page":"174-181","source":"Crossref","is-referenced-by-count":17,"title":["Clinical and ultrasound evaluation of donor site morbidity after tram\u2010flap for breast reconstruction"],"prefix":"10.1002","volume":"24","author":[{"given":"Heike","family":"Benditte\u2010Klepetko","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.","family":"Sommer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Steinbach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Czembirek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Deutinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2004,4,21]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198202000-00006"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199106000-00007"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199207000-00004"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199401000-00007"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-198402000-00008"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.1999.3099"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.1998.3033"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199901000-00015"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.2000.3427"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199206000-00007"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0007-1226(97)90540-3"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(94)90033-7"},{"key":"e_1_2_1_14_2","volume-title":"Muskelfunktionsdiagnostik","author":"Janda V","year":"1986"},{"key":"e_1_2_1_15_2","first-page":"83","article-title":"Funktionelle Defizite nach Entnahme des M. rectus abdominis","volume":"27","author":"Zauner\u2010Dungl A","year":"1995","journal-title":"Handchir Mikrochir Plast Chir"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmicr.20044","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmicr.20044","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.20044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T14:56:28Z","timestamp":1700232988000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.20044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,1]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2004,1]]}},"alternative-id":["10.1002\/micr.20044"],"URL":"https:\/\/doi.org\/10.1002\/micr.20044","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,1]]}}}