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The bipedicled free TRAM flap.

Z M Arnez¹, T Scamp

¹University Department of Plastic Surgery and Burns, University Medical Centre, Ljubljana, Slovenia.

British Journal of Plastic Surgery

|April 1, 1992

Summary

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This study presents a modified free TRAM flap technique for breast reconstruction in patients with abdominal scars. The method ensures adequate blood supply, offering an alternative to conventional TRAM flaps.

Area of Science:

Plastic Surgery
Reconstructive Surgery
Microsurgery

Background:

Abdominal scarring from previous surgeries can complicate breast reconstruction.
Free TRAM (transverse rectus abdominis myocutaneous) flaps are commonly used but can be compromised by scar tissue.
Alternative techniques are needed to ensure flap viability in challenging cases.

Observation:

Two patients with total or near-total transection of the flap by a vertical midline infraumbilical scar underwent unilateral breast reconstruction.
Both inferior epigastric pedicles were raised and anastomosed to the thoracodorsal vessels and serratus collateral.
Flap perfusion was achieved without the need for vein grafts.

Findings:

A modified free TRAM flap technique utilizing dual pedicle anastomosis was successfully employed.

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Complete flap perfusion was achieved in all cases, indicating successful revascularization.

No vein grafts were required, simplifying the surgical procedure.

Implications:

This technique is recommended for larger breast reconstruction requiring more than a hemi-TRAM flap, especially with extensive infraumbilical scarring.
It offers advantages over conventional bipedicled TRAM flaps, including avoidance of epigastric bulge and reduced abdominal wall donor site morbidity.
The improved vascularity and simplified approach enhance reconstructive outcomes in complex cases.