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[Pedicled versus free TRAM flap for breast reconstruction]
T J Galla1, B Lukas, A M Feller
1Abteilung für Plastische Chirurgie des Behandlungszentrums Vogtareuth.
Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|May 25, 1999
Summary
The free TRAM-flap offers superior outcomes in breast reconstruction with fewer complications like necrosis and minimal donor site morbidity. Despite initial concerns about microvascular surgery, this technique demonstrates a low complication rate, making it a viable option.
Area of Science:
- Plastic Surgery
- Microsurgery
- Oncologic Reconstruction
Context:
- TRAM-flap (transverse rectus abdominis myocutaneous) breast reconstruction is a common procedure.
- The pedicled TRAM-flap has been the traditional method, but the free TRAM-flap offers potential advantages.
- Patient acceptance of the free TRAM-flap has been limited by the complexity of microvascular anastomoses.
Purpose:
- To evaluate the safety and efficacy of the free TRAM-flap technique for breast reconstruction.
- To compare the complication rates and outcomes of the free TRAM-flap versus the pedicled TRAM-flap.
- To assess the learning curve and operative times associated with free TRAM-flap breast reconstruction.
Summary:
- A 13-month study involved 51 breast reconstructions in 41 patients using the free TRAM-flap.
- The procedure involved microvascular anastomoses to either thoracodorsal or internal mammary vessels.
- Complications included three revised anastomoses, one partial flap necrosis, hematomas, abdominal fat necrosis, and skin irritations; however, no abdominal hernias were observed.
Impact:
- The free TRAM-flap demonstrates a low complication rate and significant advantages over the pedicled technique, including superior perfusion and reduced donor site morbidity.
- This technique offers improved flap shaping and preservation of the rectus muscle.
- The findings support the wider adoption of the free TRAM-flap in breast reconstruction, balancing its benefits against the technical demands of microsurgery.