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TRAM flaps in patients with abdominal scars
M Takeishi1, W W Shaw, C Y Ahn
1Division of Plastic Surgery, UCLA School of Medicine, Los Angeles, Calif., USA.
Plastic and Reconstructive Surgery
|March 1, 1997
Summary
TRAM flap breast reconstruction is safe for patients with abdominal scars. While minor complications can occur, specific scar locations and patient factors like obesity and smoking require careful consideration for optimal outcomes.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
Background:
- Abdominal surgical scars can present challenges in autologous breast reconstruction.
- Transverse Rectus Abdominis Myocutaneous (TRAM) flap reconstruction is a common technique.
Observation:
- This study analyzed 114 patients undergoing TRAM flap breast reconstruction, with 46 having pre-existing abdominal scars.
- Complications were assessed in relation to scar location, type, obesity, and smoking.
- Specific scar types and patient comorbidities were evaluated for their impact on TRAM flap outcomes.
Findings:
- No flap failures or significant losses occurred.
- Minor complications (15%) included abdominal-wall weakness, partial flap loss, fat necrosis, and wound problems.
- Subcostal and multiple abdominal scars increased skin complication risk.
- Right lower paramedian scars compromised inferior epigastric vessels, precluding free TRAM flaps.
- Obesity and smoking were linked to higher wound-healing complication rates.
Implications:
- TRAM flap reconstruction is feasible and safe in patients with abdominal scars, provided technical modifications are employed.
- Careful preoperative assessment of scar patterns and patient risk factors (obesity, smoking) is crucial.
- Understanding scar impact guides surgical planning and minimizes potential complications in breast reconstruction.