Free Versus Pedicled TRAM Flaps: Cost Utilization and Complications

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Reconstructive Surgery

Background:

• Free transverse rectus abdominis myocutaneous (fTRAM) flap breast reconstruction offers benefits but requires advanced surgical expertise.
• Understanding postoperative outcomes is crucial for optimizing patient care in breast reconstruction.

Purpose of the Study:

• To compare the postoperative outcomes of free TRAM (fTRAM) versus pedicled TRAM (pTRAM) flap breast reconstruction.
• To identify risk factors associated with complications and resource utilization in TRAM flap breast reconstruction.

Main Methods:

• Analysis of the Nationwide Inpatient Sample database (2008-2011) for TRAM flap breast reconstructions.
• Inclusion criteria: females undergoing fTRAM or pTRAM; exclusion: males.
• Evaluation of demographics, comorbidities, complications, length-of-stay (LOS), and total charges (TC) using bivariate and multivariate analyses.

Main Results:

• fTRAM was associated with higher rates of obesity, revision surgery, hemorrhage control, hematoma, and wound infection compared to pTRAM.
• pTRAM showed higher rates of pneumonia and pulmonary embolism.
• Risk-adjusted analysis revealed fTRAM as an independent risk factor for increased LOS, TC, and postoperative complications.

Conclusions:

• Free TRAM flap breast reconstruction is associated with increased postoperative complications and resource utilization compared to pedicled TRAM.
• Further research is needed to fully understand factors influencing outcomes in these procedures.