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Optimal Timing of Delay Procedure in Pedicled Transverse Rectus Abdominis Muscle (TRAM) Breast Reconstruction: Pooled Analysis of Published Literature
Barkat Ali
James O'Hora
Andrew Faturos
Michelle D Palazzo
Christine M Kleinert Institute
2022-01-31
Presenter: Barkat Ali
Affidavit:
All the authors have reviewed
Director Name: Michelle Palazzo
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
In breast reconstruction, the utility of delay phenomenon for pedicled Transverse Rectus Abdominis Muscle (TRAM) flap is undisputed. However, there is no consensus on the optimal timing of flap pedicle division. We aimed to review TRAM flap delay at one week compared to greater than one week from the published literature to identify the ideal timing.
Methods
A systematic review of breast reconstruction with a pedicled TRAM flap was conducted using delay. Only original clinical studies were included. The clinical data endpoints were timing and indications of flap delay. Clinical outcomes included flap-related complications such as complete flap loss, partial flap loss, reoperation, fat necrosis, surgical site infection, and donor site morbidity, an aggregate of abdominal wall hernia, dehiscence, and infection. Pooled analysis of the published data was performed.
Results
Of the eighty-nine studies identified, eighteen met inclusion criteria. Of the total six hundred and four patients one hundred and fifty four underwent flap delay of one week compared to four hundred and fifty patients who underwent flap delay of greater than one week. The flap-related complications and donor site morbidity were not statistically different when based on delay timing.
Conclusions
This metanalysis suggests that pedicled TRAM flap delay of greater than one week compared to one week does not confer any further complication reduction.
