Pedicled transverse rectus abdominis myocutaneous flap removal after 21 years: a case report

Despite the widespread use of free abdominal based flaps for autologous breast reconstruction, the pedicled transverse rectus abdominis myocutaneous (p-TRAM) flap remains a popular alternative. Although the p-TRAM flap has been commonly utilized since the 90s, there is a paucity of information on the long-term changes that occur in the p-TRAM flap with the passage of time. Imaging studies have demonstrated changes in muscle volumes and fatty attenuation of myocutaneous flaps over time. However, the use of a histopathological approach in analysing the changes in a myocutaneous flap is rarely done as rarely do patients undergo a removal of a healthy flap. Our report seeks to show the loss of the muscle volume over time through a histopathological approach in a patient who underwent p-TRAM Flap removal after 21 years.