The "circummuscular" free TRAM pedicle: a trap

A variation of the deep inferior epigastric system is presented in which the vessels or their dominant branches do not enter the rectus muscle at any point on its deep surface. Full submuscular exploration of the deep inferior epigastric pedicle is proposed as a necessity (prior to muscle section) if flap loss is to be avoided during efforts to raise free TRAM flaps with minimal muscle harvest.