Necrosis of abdominoplasty and other secondary flaps after TRAM flap breast reconstruction

The risks of abdominoplasty flap necrosis, umbilical necrosis, and mastectomy flap edge necrosis were compared in a series of 227 patients who had undergone transverse rectus abdominis myocutaneous (TRAM) flap breast reconstructions. Abdominoplasty flap necrosis was more common in patients who smoked or previously had smoked (27.5 percent) than in nonsmokers (5.9 percent). It also was more common in patients who had had conventional TRAM flaps (16.5 percent) than in those with free TRAM flaps (7.8 percent). Similarly, umbilical necrosis was more common in smokers (27.5 percent) than in nonsmokers (11.8 percent). Current smokers had higher risks than ex-smokers, who in turn had higher risks than patients who had never smoked. Obesity appeared to have only a minor influence on abdominal flap and umbilical necrosis. Mastectomy flap edge necrosis, which had little or no impact on the final outcome, was more common after free TRAM flaps than after conventional TRAM flaps.