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ISSN 2992-8559 (Electronic)
ISSN 1405-0625 (Print)

2001, Number 2

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Cir Plast 2001; 11 (2)

Breast reconstruction using free TRAM flap. Is risk justifiable?

Santamaría LE, Ramírez UMT, Ochoa CF, Fuentes AA

Language: Spanish
References: 19
Page: 49-60
PDF size: 2067.03 Kb.


ABSTRACT

The experience in 39 cases of unilateral breast reconstruction using a free TRAM flap in 18 patients and pedicled TRAM flap in 21 is presented, comparing clinical results between both groups. Reconstruction was immediate in 17 (7 free and 10 pedicled), and delayed in 22 patients (11 free and 11 pedicled). Recipient vessels used in 18 free TRAM flaps were the thoracodorsal vessels in five patients and the internal mammary in 13 patients. The results were assessed using a questionnaire and clinical findings, one case of free TRAM flap loss in the delayed reconstruction group; partial skin and subcutaneous tissue island necrosis in three pedicled flaps and one free flap (p › 0.05). Variable fat necrosis was noted in eleven patients with pedicled TRAM flaps and was absent in the free TRAM flap group (p ‹ 0.05). Abdominal wound dehiscence was present in three pedicled TRAM flap; eight patients noted epigastric bulging and four referred abdominal muscle functional weakness. No donor site complications were observed in the free TRAM patients and no major difference between immediate and delayed breast reconstruction. Aesthetic results were classified either as good, moderate or poor. The pedicled TRAM flap is a good surgical option for breast reconstruction in patients having enough fat tissue in I and II zones. Fat necrosis incidence and partial loss are higher when zone III is incorporated in the pedicled TRAM flap; therefore this should not be used for breast reconstruction in those patients with opposite large breast, who want to preserve a considerable breast size. Free TRAM flap offers more advantages than the pedicled TRAM flap, however the risk of total failure should be clearly explained and accepted by the patient.


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