The increase in TRAM flap survival after delay does not diminish long term

The delay phenomenon is sometimes relied on to increase survival of the transverse rectus abdominis musculocutaneous (TRAM) flap in high-risk patients. TRAM reconstruction has then been performed traditionally 1 to 2 weeks after the delay procedure. The optimum time course from this surgical delay to flap elevation, as it relates to survival, has not been well studied--specifically whether the potential benefit of delay lessens at any particular time after the delay procedure. The authors examined the effects of varying time periods (up to 7 months) after delay, via division of the dominant bilateral superior epigastric vessels, on the viability of the TRAM flap in a rat model. TRAM flap survival improved significantly (p < 0.01) at all time points in delayed groups compared with a nondelayed control group. The benefit of delay in this model was maintained at all times, even long term. In conclusion, it may be possible to extend the delay period safely beyond the customary 1 to 2 weeks without compromising survival of the TRAM flap, which may prove to be more convenient.