[Complications and abdominal wall sequelae in pedicle TRAM breast reconstruction]

The doubts concerning silicon implants since 1991 have led to the development of autologous tissue reconstruction and especially pedicle rectus abdominis flap (TRAM). The good cosmetic results obtained on the reconstructed breast also promoted the development of this technique. However, the complications and donor site sequelae must not be underestimated. The abdominal wall is considerably modified in terms of muscle strength and residual scars. It can be the site of complications such as herniae and scar necrosis. In order to more accurately assess these risks, the authors studied a series of 251 TRAM breast reconstructions performed at the Institut Gustave-Roussy between 1982 and 1992. The rate of herniae requiring reoperating decreased considerably with improvement of the technique, falling from 10% to less than 2% in the most recent cases, with a mean rate of 7% for the overall series. Infraumbilical scar necrosis was not exceptional, but the incidence appeared to decline with the surgeon's experience (about 5%). This depended on the patient's clinical context, especially a history of smoking. The strength of contraction of the upper segment of the muscle was significantly decreased and the cosmetic results of the abdominal scar were not always favourable as they were considered to be satisfactory in only 70% of cases. This study demonstrates the importance of not underestimating the sequelae of donor site scars, which must be taken into account when evaluating the results of the technique.