[The transverse rectus abdominis muscle (TRAM) flap. A "second defensive line" in microvascular reconstructions of defects in the head and neck area]

The microvascular anastomosed transverse rectus abdominis muscle (TRAM) island flap has been successfully used in plastic surgery for more than 10 years. In reconstructive head and neck surgery, however, it is not yet established.

We analysed the preparation and anatomical variation in TRAM flaps in an examination of eight cadavers. In a clinical case with complete reconstruction of the nose after nasal ablation and complete loss of a radial lower forearm flap that had been transplanted previously due to a recurrent tumor, the possibility of forming and modeling a TRAM flap is demonstrated.

The flap vessels of the TRAM are comparable to the radial forearm flap, and the donor site may be primarily closed. The TRAM proved to be a suitable alternative to close lesions of the head and neck area in selected cases. The myocutaneous TRAM is bulkier than the fascio-cutaneous radial forearm flap. The subcutaneous abdominal fat of the TRAM can be reduced in relation to the vascular distribution of the perforator vessels. If the subcutaneous fat of the flap is reduced, the flap can be shaped and formed well. In the described case, it was used to close the lesion after ablation of the nose and middle face.

The risk of an iatrogenic lesion of the peritoneal fascia or postsurgical herniation of the abdominal wall is low if several surgical prerequisites are taken into consideration. The myocutaneous TRAM will not replace the fascio-cutaneous radial forearm flap in microvascular head and neck surgery, but the large diameter of the donor vessels and the highly vascularized flap tissue makes it an alternative as a second line procedure in cases of unfavorable wound conditions.