Evaluation of abdominal wall strength after TRAM flap surgery

Evaluation of abdominal wall function after transverse rectus abdominis musculocutaneous (TRAM) flap surgery has been mostly subjective. The purpose of this study was to measure abdominal wall strength objectively and to compare the results with the patient's performance of daily activities. Abdominal wall strength was objectively measured with the B200 IsoStation machine preoperatively and 1 year after TRAM flap breast reconstruction. These data were compared with the results of a questionnaire evaluating the patient's performance of daily activities. The results of this testing in 21 patients demonstrated the following: (1) a decrease in abdominal wall strength after bilateral pedicled TRAM flap surgery, which was significant in trunk flexion (34.2 +/- 16.9 ft-lbs to 20.6 +/- 15.2 ft-lbs); (2) compensation by other truncal musculature, with an increase in the strength of trunk rotation (18.8 +/- 13.5 ft-lbs to 28.6 +/- 17.7 ft-lbs) seen after unilateral pedicled TRAM flap surgery; (3) minimal interference with the patient's daily activities; and (4) no effect of mesh on strength. A relationship was demonstrated between the degree of loss of strength in trunk flexion and the patient's difficulty in performing certain activities. The patients who had the greatest loss in trunk flexion following the use of both pedicles also had the most difficulty in performing some daily activities. The patients were satisfied with their reconstructive procedure, with an average score of 8.3 (on a scale of 1 to 10), and reported an improvement in the appearance of their abdomen, with an average increase of 5.1 to 6.8 (on a scale of 1 to 10).