The vascular anatomy of the inner anterior abdominal wall with special reference to the transversus and rectus abdominis musculoperitoneal (TRAMP) composite flap for vaginal reconstruction.

This study was designed to clarify the vascularization of the inner anterior abdominal wall with respect to the novel transversus and rectus abdominis musculoperitoneal (TRAMP) flap, which was introduced recently for vaginal reconstruction. A series of human cadavers was injected with a lead oxide-gelatine mixture by means of the deep inferior epigastric artery and subsequently dissected and examined by radiography. In all cases we found that the blood supply of the entire rectus abdominis muscle from the symphysis to the costal arch and that of the medial 10 to 15 cm of the transversus abdominis muscle, as well as the underlying peritoneum, was provided by several branches of the deep inferior epigastric artery. "Choke" arteries to the superior epigastric artery and also to the intercostal arteries (X, XI, and XII) have been shown to be common features. From the anatomic point of view, these observations offer the possibility of mobilizing large parts of the transversus abdominis muscle together with the rectus abdominis muscle for reconstructive surgery.