Breast Reconstruction with Microvasculary Augmented TRAM Flap
12(3) : 173-181
Article Type: Original Article
Abstract: Modem trends in breast reconstruction with TRAM flap have promoted adequate blood supply to the flap while minimizing the donor site defect in the anterior ab-dominal wall. To improve the blood supply of the pedicled flap we have performed an additional microvascular aug-mentation to this type of breast reconstruction procedure since 1998. Twenty supercharged TRAM flaps were per-formed for breast reconstruction after modified radical mastectomy. There were 19 immediate and one delayed reconstruction. The contralateral deep inferior epigastric pedicle was anastomosed to the thoracodorsal vein and ar-tery. Reinforcing polypropylene mesh was applied rou-tinely for abdominal closure. For the arterial anastomoses this technique proved to be feasible in all patients. For the venous anastomoses only in 3 of 20 patients the anasto-moses failed. There is no single case of total or partial flap loss. Fat necrosis was observed in 10% of cases. The inci-dence of abdominal bulge or hernia was zero percent. The supercharged TRAM flap produces an improvement in vascularity that permits use of all four zones of the flap. It minimizes the risk of total flap loss. The main disadvan-tage is less freedom in positioning the flap due to the pres-ence of the superior muscular pedicle.