TRAM flap vascular delay for high-risk breast reconstruction

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Breast Reconstruction

Background:

• The transverse rectus abdominis myocutaneous (TRAM) flap is a common method for immediate breast reconstruction.
• Vascular delay is a surgical technique used to improve flap perfusion and reduce complications.
• Fat necrosis remains a concern in TRAM flap breast reconstruction, particularly in high-risk patients.

Purpose of the Study:

• To evaluate intraoperative changes in blood pressure following vascular delay of the TRAM flap.
• To assess the impact of vascular delay on TRAM flap perfusion pressure.
• To determine the safety and efficacy of TRAM flap delay in high-risk breast reconstruction patients.

Main Methods:

• Ligation of superficial and deep inferior epigastric vessels was performed 2 weeks prior to TRAM flap elevation.
• Direct blood pressure measurements were taken in the deep inferior epigastric artery and vein.
• A control group (no delay) and a study group (vascular delay) were compared.
• TRAM flap perfusion pressure was measured before and after flap transfer to the chest.

Main Results:

• Arterial pressure in the deep inferior epigastric artery proximal stump was 64% in the delayed group vs. 72% in the control group prior to delay.
• Physiologic response included increased arterial pressure and decreased venous congestion.
• TRAM flap perfusion pressure significantly increased from 13.3 mmHg (control) to 40.3 mmHg (delayed) in the midrectus perforator region (p < 0.05).
• Fat necrosis incidence was 4.3% in 30 high-risk patients undergoing immediate breast reconstruction with vascular delay.

Conclusions:

• TRAM flap vascular delay technique increases reliable tissue volume.
• The procedure improves the safety of TRAM flaps for breast reconstruction.
• Vascular delay is a beneficial adjunct for high-risk TRAM flap breast reconstruction.