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Pedicle TRAM Flap Breast Reconstruction: A 10-Year Review of One Surgeons Experience
Lewis A Diulus III MD, FACS, Douglas S. Wagner MD
SUMMA
2014-02-25
Presenter: Lewis A. Diulus MD
Affidavit:
This data was collected completely by myself and is original.
Director Name: Douglas S Wagner
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
For over 30 years, the pedicled TRAM flap has been the gold standard for autogenous breast reconstruction. Serious abdominal wall donor site complications have caused some microvascular surgeons to criticize the pedicled TRAM flap on the basis of these poor results. We sought to review our experience with this flap to either confirm or refute the claim
Methods:
A ten-year retrospective review of 207 pedicled TRAM flap reconstructions by a single surgeon was performed. Age, BMI, comorbidities, complications, revision, and patient self-assessment of abdominal wall function were recorded and analyzed.
Results:
There were 293 reconstructions, 96 two-muscle harvest (86 bilateral, 7 double pedicle, and 3 unipedicle with contralateral free) and 111 unilateral single muscle harvests.. Nipple reconstructions were performed in 143 patients. There were 336 complications (99 major/229 minor) in an average of 1.62 per patient. There were no complications in 55 patients, 84 had only minor and 68 had major complications. Complication severity increased with increasing BMI: 26.25, 28.85 and 30.63 respectively. Abdominal wall issues were seen in 33 patients: nine supraumbilical hernias (5 required repair), 19 lower bulges and one hernia. Issues were more common with single pedicle 21(72.4%) then double pedicle 8(27.6%) reconstruction. There were nine mesh infections with five hernias after mesh removal. All patients completed reconstruction, four requiring rescue latissimus flaps.
Conclusion
There were no serious abdominal wall complications and all bulges were successfully repaired. Based on our review, the pedicle TRAM flap is a safe and effective method for breast reconstruction.
