Donor-site morbidity after pedicled or free TRAM flap surgery: a prospective and objective study

The main disadvantage when the transverse rectus abdominis musculocutaneous (TRAM) flap is used for breast reconstruction is the potential for weakening of the abdominal wall. This prospective study was initiated to objectively evaluate abdominal muscle strength after pedicled and free TRAM flap breast reconstructions over time. Twenty-three patients with pedicled TRAM flaps and 19 patients with free TRAM flaps were included. A dynamic dynamometer system, KIN-COM, was used to measure maximal voluntary trunk flexor and extensor strength preoperatively and 6 and 12 months postoperatively. The patients' subjective opinions 1 year postoperatively were recorded by means of a questionnaire. A transient decrease in abdominal strength, in both groups, occurred at 6 months but was essentially regained at 12 months. The use of a pedicled or free TRAM flap did not influence postoperative abdominal strength per se. The balance between the abdominal strength and back strength remained in the free flap group but was altered postoperatively in the pedicled flap group; back strength was increased and remained so after 12 months. The difference between the two procedures is relatively small compared with individual variations, indicating that there are more important factors than the kind of surgery influencing the restoration of muscle strength. The questionnaire revealed a greater occurrence of abdominal wall bulging in the free flap group (82 percent) versus 48 percent in the pedicled flap group. No postoperative differences regarding exercise frequency or sensitivity of the abdominal wall were found between the pedicled and free TRAM flap groups.