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Does Prior Surgical Delay Preclude Microvascular Supercharging of TRAM Flaps?
Reuben B, White M, Heckler F
University of Pittsburgh
2010-03-28
Presenter: Brian Reuben
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: A delayed pedicled transverse rectus abdominus myocutaneous (TRAM) flap remains one of the most popular methods for breast reconstruction. We questioned whether prior surgical ligation of the deep inferior epigastric artery (DIEA) or vein (DIEV) would make subsequent microvascular supercharging impossible.
Methods: Data from 22 patients undergoing a delay procedure prior to TRAM flap breast reconstruction was prospectively gathered. The DIEA/V were ligated close to the iliac vessels. The second stage of the pedicled TRAM took place between 10-21 days from the initial delay. A 3cm measured segment of DIEA/V was then excised, mounted, serially sectioned and divided in three equal 1cm segments (adjacent to ligature and serially 2cm proximal). Microscopic examination of the lumen was undertaken. Presence or absence of clinical bleeding from the DIEA/V was also noted.
Results: 22 patients underwent a surgical delay of their pedicled TRAM flap. Only two specimens showed clot in the distal segment (closest to the ligature). The remaining 20 specimens showed clot immediately adjacent to the ligature only with the remaining distal segment otherwise clear of thrombus. The proximal two segments of these samples were all free from thrombus. All specimens demonstrated clinically detectable bleeding from the DIEA/V. In one case a successful microvascular supercharging was performed from the DIEA to the thoracodorsal artery.
Conclusion: The lack of thrombus in the segments of a previously delayed DIEA/V support the possibility for subsequent microvascular supercharging of the pedicled TRAM flap in the event of arterial insufficiency or venous congestion of the flap.
