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The surgically delayed unipedicled TRAM flap for breast reconstruction
1Department of Plastic and Reconstructive Surgery, Groote Schuur Hospital, Cape Town, South Africa.
Annals of Plastic Surgery
|March 1, 1996
Summary
Surgical delay enhances blood supply to TRAM flaps for breast reconstruction. This technique, applied before flap elevation, yielded good aesthetic results with minor complications in high-risk patients.
Area of Science:
- Plastic Surgery
- Surgical Oncology
- Breast Reconstruction
Background:
- Transverse rectus abdominis musculocutaneous (TRAM) flaps are used in breast reconstruction.
- Enhancing flap vascularity is crucial for successful outcomes.
- Surgical delay is a potential method to improve TRAM flap vascularity.
Purpose of the Study:
- To evaluate the outcomes of surgical delay in TRAM flap breast reconstruction.
- To assess the safety and efficacy of ligating epigastric vessels prior to flap elevation.
Main Methods:
- Seven patients underwent surgical delay by bilateral ligation of superficial and deep inferior epigastric vessels one week before TRAM flap elevation.
- Patient characteristics included smokers, obese individuals, and those with asthma.
Main Results:
- All patients achieved satisfactory aesthetic results.
- Minor complications included skin necrosis in two patients and fat necrosis in three patients.
- The technique was effective in high-risk patient populations.
Conclusions:
- Surgical delay is a valuable technique for TRAM flap breast reconstruction.
- It improves flap vascularity and allows safe centering of the flap.
- This method may reduce the need for microsurgery or rectus abdominis muscle sacrifice in high-risk patients.