Thermal injuries following TRAM flap breast reconstruction

Following transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction there are predictable sensory changes in both the abdominal skin and the skin of the reconstructed breast. Cutaneous anesthesia and dysesthesias are troublesome and annoying for many patients. More importantly, these sensory changes can lead to burn injury in the uninformed patient. Over the past 9 years 5 of our patients have sustained third-degree burn injuries to the skin following breast reconstruction with the TRAM flap. Four of these occurred while sunbathing while wearing a black bathing suit and one was the result of a direct thermal injury. Two patients sustained injuries to the breast, 2 patients experienced injuries to the abdomen, and 1 patient experienced injuries to both sites. All of these untoward events occurred within the initial 4 months following surgery. Four patients healed with topical wound treatment but 1 patient required a full-thickness skin graft to optimize cosmesis of the reconstructed breast. Patient examples illustrating burn injuries and treatment outcomes are shown. Mechanisms involved are sensory and thermoregulatory loss locally at the anterior abdominal wall and at the reconstructed breast. The reinnervation potential according to experimental and clinical studies is reviewed. There are sensory and thermoregulatory changes in the skin at the donor and recipient site during TRAM flap breast reconstruction. Patients should be carefully informed about these and warned to avoid prolonged contact with hot objects and sun exposure, especially when wearing a dark-colored swimsuit.