Breast reconstruction with free transverse rectus abdominis myocutaneous flaps in hospitals unaccustomed to...

We studied retrospectively 102 consecutive free TRAM breast reconstructions that were done outside our own hospital in hospitals that were not used to microsurgical techniques. Twenty-three patients were operated on by an uninfiltrated free TRAM technique, and 79 had 0.5% lignocaine with adrenaline infiltrated along the incision lines before the operation. We lost two flaps and six flaps developed necrosis of the medial edge. Our total complication rate (25%) compared well with those of other studies. Infiltration with lignocaine and adrenaline significantly decreased the operating time (mean (SD) 234 (91) compared with 159 (40) minutes), peroperative bleeding (930 (530) ml compared with 350 (180) ml), peroperative transfusions, and the total number of transfusions, so improving the cost:effect ratio of free TRAM breast reconstructions. Microsurgical free TRAM breast reconstructions can be done with good results in peripheral hospitals.