Delaying the skin for TRAM flaps

This study was undertaken to determine whether a less extensive delay procedure would be as efficacious as the standard delay procedure in breast reconstruction.Between July 1996 and February 1999, 15 patients underwent delay procedures prior to breast reconstruction. Six patients underwent the standard delay procedure. Nine patients underwent a less extensive skin delay procedure. Transverse rectus abdominis myocutaneous (TRAM) reconstruction was performed 1 week after delay procedures.Average operating time was 28.7 minutes for the standard delay and 19.7 minutes for the skin paddle delay. The incidences of fat necrosis were 17% in the standard delay group and 22% in the skin paddle delay group. The incidences of partial flap loss/slow healing were 17% in the standard delay group and 22% in the skin paddle delay group. The incidence of complications in each group was the same: approximately 1 per patient.Operating times were not statistically different between the two groups (p = 0.06). There was no increase in the incidence of slow healing/partial flap loss or fat necrosis in the skin delay group. The skin delay procedure for TRAM flaps seems to provide a concise delay procedure that does not increase the incidence of complications in those high-risk patients.