Transverse Rectus Abdominis Myocutaneous Flap: A Gold Standard for Immediate
Adel M. Wilson, M.D. FRCS.; Samy
M.I. Said M.D., and Tarek A. Said, M.D.
Surgery Department, Faculty of Medicine, Cairo University.
Med. J. Cairo Univ., Vol (71),
No (4),(Suppl), Dec.: 11-19, 2003
Pedicled transverse rectus abdominis
myocutaneous (TRAM) flaps have been used with an increasing frequency in
immediate breast reconstruction following mastectomy. The high incidence
of venous compromise and partial flap necrosis rendered the outcome unsatisfactory
in several patients. Cadaver studies that demonstrated presence of valves
in the inferior epigastric vein that impede retrograde flow, led to the
logic modification of performing a supradrainage augmentation of that vein
into the thoracodorsal vein.
In the present study 20 conventional
contralateral TRAM flaps were used as a primary procedure for breast reconstruction
with supradrainage augmentation. The 90% success rate suggests that
this procedure that constitutes very little additional operative renders
the surgery much safer and markedly improves flap survival. It is strongly
recommended to done in all TRAM reconstructions.