Comparison of TRAM and DIEP flap physiology in a rat model

Dynamic and physiologic studies objectively comparing the attributes of the transverse rectus abdominis musculocutaneous (TRAM) and deep inferior epigastric perforator (DIEP) flaps would be most practical in an animal model. This has now been accomplished using the ventral abdomen of the Sprague-Dawley rat. A conventional TRAM flap, a multiple perforator DIEP flap, and a solitary perforator DIEP flap were raised in three equal groups of five rats each. Flow studies using laser Doppler flowmetry demonstrated the highest flow in zone I in the TRAM flap group (87.6 +/- 15.4 percent), which was a statistically significant difference from the multiple perforator DIEP flap group (45.4 +/- 13.3 percent) and the solitary perforator DIEP flap group (43.4 +/- 26.4 percent) (p = 0.005). Flow in zone IV was proportionately lower for all groups, with no significant difference noted between TRAM and DIEP flaps (p = 0.736). Although ultimate flap survival was greatest for the TRAM flap group (96.1 +/- 6.7 percent) when compared with the multiple perforator DIEP flap (79.8 +/- 15.2 percent) or the solitary perforator DIEP flap groups (77.1 +/- 23.0 percent), this difference was not statistically significant (p = 0.183). In summary, relative flow to these rat ventral abdomen models was directly proportional to the number of retained musculocutaneous perforators, but a single perforator only could routinely allow near-total survival.