A Fleur de Lys modification of the TRAM flap for breast reconstruction

A major problem of the standard TRAM flap is uncertain vascularity. Many modifications have been made to overcome this problem, but they usually lead to an increase in both the duration and complexity of the operative procedure. The modification described here uses a single muscle pedicle flap, but adds a vertical component comprising the well vascularised tissue above the umbilicus in continuity with the usual horizontal skin flap. This has the advantage of greater volume of available tissue, much improved blood supply, shorter operative time, greater exposure for dissection, a technically more simple procedure, and quicker recovery. The vertical and horizontal skin flaps are approximated as a cone to provide excellent breast projection. All this can be achieved at the cost of a vertical abdominal scar, which is well accepted when explained to patients.