Abstract
Breast reconstruction with a unipedicled transverse rectus abdominis myocutaneous (TRAM) flap, originally developed by Carl Hartrampf, is a breast reconstruction procedure that is widely used because it allows a final reconstruction without a prosthesis with a natural result and is stable over time. There are two specific complications: skin fatty tissue necrosis and parietal complications such as hernias or bulges, for which there are measures to take and adapted treatments. To reduce the risk of necrosis, the bipedicled TRAM flap and the TRAM flap with strengthening of the vasculature by microsurgical techniques (supercharged TRAM flap and free TRAM flap) have been proposed. To reduce parietal complications , microsurgical techniques with preservation of the rectus abdominis muscle (deep inferior epigastric perforator flap and superficial inferior epigastric artery flap) have appeared. In our experience of the unipedicled TRAM flap, careful selection of patients, a delayed procedure, and meticulous repair of the abdominal wall are preventive measures for these complications. As a result, the rate of complications has been significantly reduced, strengthening the indication for the unipedicled TRAM flap compared with other TRAM flap techniques.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hartrampf CR Jr, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69:216–225
Grotting JC, Urist MM, Maddox WA et al (1989) Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction. Plast Reconstr Surg 83:828–839
Schusterman MA, Kroll SS, Miller MJ et al (1994) The free transverse rectus abdominis musculocutaneous flap for breast reconstruction: one center’s experience with 211 consecutive cases. Ann Plast Surg 32:234–241
Blondeel PN (1999) One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 52:104–111
Chevray PM (2004) Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. Plast Reconstr Surg 114:1077–1083
Clough K, O’Donoghue J, Fitoussi A et al (2001) Prospective evaluation of late cosmetic results following breast reconstruction. Plast Reconstr Surg 107:1710–1716
Jones G (2007) The pedicled TRAM Flap in breast reconstruction. Clin Plast Surg 34:83–104
Granzowa JW, Levineb JL, Chiub ES, Allen RJ (2006) Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique. J Plast Reconstr Aesthet Surg 59:571–579
Caplin DA, Nathan CR, Couper SG (2000) Salvage of TRAM flaps with compromised venous outflow. Plast Reconstr Surg 106:400–401
Olsson E, Höijer P (2005) Activated protein C resistance due to factor V Leiden, elevated coagulation factor VIII and postoperative deep vein thrombosis in late breast reconstruction with a free TRAM flap: a report of two cases. Br J Plast Surg 58:720–723
Kroll SS, Gherardini G, Martin JE et al (1998) Flap necroses in free and pedicled TRAM flaps. Plast Reconstr Surg 102:1502–1507
Garvey PB, Buchel EW et al (2006) DIEP and pedicled TRAM flaps: a comparison of outcomes. Plast Reconstr Surg 117:1711–1719
Kroll SS (2000) Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 106:576–583
Bozikov K, Arnez T, Hertl K et al (2009) Fat necrosis in free DIEP flaps: incidence, risk, and predictor factors. Ann Plast Surg 63:138–142
Petit JY, Rietgens M, Garusi C et al (2003) Abdominal complications with pedicled TRAM flap: is there still an indication for pedicled TRAM in the year 2003? Plast Reconstr Surg 112:1063–1065
Ascherman JA, Seruya M et al (2008) Abdominal wall morbidity following unilateral and bilateral breast reconstruction with pedicled TRAM flaps: an outcome analysis of 117 consecutive patients. Plast Reconstr Surg 121:1–8
Man LX, Selber JC, Serletti JM (2009) Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis and critical review. Plast Reconstr Surg 124:752–764
Bhat W, Akhtar S, Akali A (2010) Pregnancy in the early stages following DIEP flap breast reconstruction: a review and case report. J Plast Reconstr Aesthet Surg 63:782–784
Padubidri AN, Yetman R, Browne E et al (2001) Complications of postmastectomy breast reconstructions in smokers, ex-smokers, and nonsmokers. Plast Reconstr Surg 107:342–349
Spear SL, Ducic I, Cuoco F, Taylor N (2007) Effect of obesity on flap and donor-site complications in pedicled TRAM flap breast reconstruction. Plast Reconstr Surg 119:788–795
Wallace AM, Evans GRD, Goldberg DP et al (1996) Unexpected vascular compromise in transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction. A report of two patients. Ann Plat Surg 36:246–250
Codner MA, Bostwick J, Nahai F et al (1995) TRAM flap vascular delay for high risk breast reconstruction. Plast Reconstr Surg 96:1615–1622
Taylor GI, Corlett RJ, Caddy CM, Zelt RG (1992) An anatomic review of the delay phenomenon: II. Clinical applications. Plast Reconstr Surg 89:408–417
Holm C, Mayr M, Hofter E, Ninkovic M (2006) Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 117:37–43
Taylor GI (1999) The delayed TRAM flap for breast reconstruction: why, when, and how? Operat Techn Plast Reconstr Surg 6:74–82
O’Shaugnessy K, Mustoe T (2008) The surgical TRAM flap delay: reliability of zone III using a simplified technique under local anesthesia. Plast Reconstr Surg 122:1627–1633
Spear SL, Wilson HB, Lockwood MD (2005) Fat injection to correct contour deformities in the reconstructed breast. Plast Reconstr Surg 116(5):1300–1305
Restifo RJ, Ward BA, Scoutt LM, Brown JM, Taylor KJW (1997) Timing, magnitude, and utility of surgical delay in the TRAM flap: II. Clinical studies. Plast Reconstr Surg 99:1217–1223
Restifo RJ, Ahmed SS, Rosser J et al (1998) TRAM flap perforator ligation and the delay phenomenon: development of an endoscopic/laparoscopic delay procedure. Plast Reconstr Surg 101:1503–1511
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Italia
About this chapter
Cite this chapter
Piat, JM. (2013). Complications of Unipedicled TRAM Flap Reconstruction: Treatment and Prevention (and Their Influence on the Choice of the Reconstruction). In: Urban, C., Rietjens, M. (eds) Oncoplastic and Reconstructive Breast Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2652-0_35
Download citation
DOI: https://doi.org/10.1007/978-88-470-2652-0_35
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2651-3
Online ISBN: 978-88-470-2652-0
eBook Packages: MedicineMedicine (R0)