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Angiographic delay: a viable alternative to surgical delay.

Sharline Z Aboutanos¹, Efstathios Spinos, Nadia P Blanchet

¹Department of Plastic and Reconstructive Surgery, 9210 Forest Hill Ave., Richmond, VA 23235, USA.

Annals of Plastic Surgery

|June 2, 2011

Summary

Selective arterial embolization for transverse rectus abdominis musculocutaneous (TRAM) flap delay shows outcomes comparable to surgical delay. Smoking remains a significant risk factor for TRAM flap fat necrosis.

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Area of Science:

Plastic Surgery
Vascular Surgery
Breast Reconstruction

Background:

Transverse rectus abdominis musculocutaneous (TRAM) flap delay can be achieved via selective inferior epigastric artery embolization.
This study compares angiographic delay to traditional surgical delay methods for TRAM flaps.

Purpose of the Study:

To compare TRAM flap outcomes after selective arterial embolization with historical surgical delay controls.
To identify risk factors for TRAM flap fat necrosis following angiographic delay.

Main Methods:

Retrospective chart review of 88 patients undergoing unilateral TRAM flap breast reconstruction.
Selective embolization of bilateral inferior epigastric arteries was performed prior to flap elevation.

Main Results:

No flap skin necrosis or total flap loss occurred in 88 pedicled TRAM flaps.
13.6% of patients experienced TRAM flap fat necrosis.
Smoking history was a significant risk factor for TRAM flap fat necrosis (P=0.048).

Conclusions:

Pedicled TRAM flaps delayed by selective arterial embolization demonstrate outcomes comparable to surgical delay.
Angiographic delay is superior to non-delayed flaps.
Smoking remains a critical risk factor for TRAM flap fat necrosis, even after delay.