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Free perforator crossover TRAM flap for breast reconstruction
Thomas C Lam1, Graham D Sellars
1Department of Plastic and Reconstructive Surgery, N.S.W. Breast Cancer Institute, Westmead Hospital, Sydney, Australia.
Annals of Plastic Surgery
|February 5, 2003
Summary
A new free perforator crossover TRAM flap offers reliable breast reconstruction for patients with prior midline abdominal scars. This technique ensures adequate blood supply, overcoming previous limitations in autogenous tissue breast reconstruction.
Area of Science:
- Plastic Surgery
- Microsurgery
- Breast Reconstruction
Background:
- Transverse rectus abdominis musculocutaneous (TRAM) flap is a preferred autogenous breast reconstruction method.
- Superiorly pedicled TRAM flaps have variable perfusion to distal zones, especially with midline scars.
- Previous augmentation techniques for TRAM flaps include delay procedures, bipedicled flaps, supercharging, and turbo-charging.
Observation:
- The deep inferior epigastric artery is the dominant blood supply for TRAM flaps.
- Microsurgical free TRAM flaps based inferiorly offer reliable perfusion, even to zone 4.
- Midline crossover circulation in TRAM flaps relies on the subdermal plexus, which is compromised by vertical midline scars.
Findings:
- Perfusion across vertical midline scars in TRAM flaps is unreliable, limiting autogenous reconstruction options for many patients.
- A free perforator crossover TRAM flap utilizes a constant premuscular branch of the deep inferior epigastric artery and vein.
- This technique provides a reliable option for autogenous tissue breast reconstruction in patients with previous midline scars.
Implications:
- The free perforator crossover TRAM flap expands reconstructive possibilities for breast cancer patients.
- This method addresses the limitations of traditional TRAM flaps in the presence of midline abdominal scarring.
- It offers a genuine autogenous tissue option, potentially improving outcomes and patient satisfaction.