TRAM Flap Postoperative Care and Complications

Summary

TRAM flap breast reconstruction is major surgery and requires careful postoperative management of fluids and pulmonary function. Dehydration and atelectasis should be prevented or treated, as should gastric dilatation. If a free flap has been performed, postoperative flap monitoring is performed hourly for 3 days. If significant partial flap loss occurs, it should be treated aggressively with early debridement and, if necessary, tissue replacement. Abdominal bulges and hernias should be prevented by meticulous and secure closure of the fascial donor site (or sites). If they occur despite all efforts, they should be repaired aggressively by exposing the dehiscent internal oblique layer and attaching it securely to the midline fascia with heavy permanent running suture, often (especially in bilateral cases) adding reinforcement with synthetic mesh.