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Mark W. Clemens, MD • Houston, Texas

TRAM flap donor site reinforcement using SERI® Surgical Scaffold for soft tissue support

Operative technique

Step 1: Dr. Clemens completed the muscle-sparing TRAM flap reconstruction of the right chest wall and contralateral breast reduction for symmetry [Figure 1].

Step 2: SERI® Surgical Scaffold was placed for inlay reinforcement of the soft tissue of the abdominal donor site. A sheet of SERI® Surgical Scaffold was cut into a 6-cm x10-cm piece and rinsed with normal saline and triple antibiotic solution. The piece of SERI® Surgical Scaffold was inset under tension in the inlay plane of the donor site [Figure 2].

Figure 1. Donor site for the muscle-sparing TRAM flap

Figure 2. SERI® Surgical Scaffold inserted into the inlay plane

Figure 3. #1 Prolene® figure-of-8 followed by running suture to close the fascia over SERI® Surgical Scaffold

Figure 4. Scarpa’s fascia closed with 2-0 PDS interrupted sutures

Step 3: The scaffold was tacked into place with nonabsorbable #1 Prolene® interrupted figure-of-8 sutures circumferentially, approximately 1 cm to 2 cm apart. The anterior rectus fascia was then closed without tension using figure-of-8 sutures followed by a running #1 Prolene® suture [Figure 3].

Step 4: Two 15-French round hubless Blake® drains on a 3/16-inch trocar were placed in the abdomen through separate stab incisions above the pubis. Scarpa’s fascia was closed with 2-0 PDS interrupted sutures [Figure 4], and the skin was closed with 3-0 Monocryl® dermal sutures followed by 4-0 Monocryl® subcuticular sutures.

This Case Review is provided for your information only. As with other surgical and medical decisions, it is the responsibility of surgeons to use sound medical judgment in utilizing the procedures best suited to the needs of each patient and to the skills and experiences of the surgeon. Please refer to the SERI® Surgical Scaffold Instructions for Use for current information.

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Indications for Use
SERI® Surgical Scaffold is indicated for use as a transitory scaffold for soft tissue support and repair to reinforce deficiencies where weakness or voids exist that require the addition of material to obtain the desired surgical outcome. This includes reinforcement of soft tissue in plastic and reconstructive surgery, and general soft tissue reconstruction.

Important Safety Information

Contraindications

  • Patients with a known allergy to silk
  • Contraindicated for direct contact with bowel or viscera where formation of adhesions may occur

Warnings

  • SERI® Surgical Scaffold must be placed in maximum possible contact with healthy well-vascularized tissue to encourage ingrowth and tissue remodeling
  • Caution should be used when implanting SERI® Surgical Scaffold in pregnant women. The use of a device that can impede tissue expansion may be hazardous during pregnancy

Adverse Reactions
Adverse reactions are those typically associated with surgically implantable materials, including infection, inflammation, adhesion formation, fistula formation, and extrusion.