title: TRAM flap anatomy correlated with a 10-year clinical experience with 556 patients.
abstract: This study examines the vascular anatomy of the TRAM flap and evaluates risk factors associated with complications among 556 women who had TRAM flap breast reconstruction. Fifty-nine patients (10.6 percent) developed fat necrosis involving 10 percent or more of their breast. Risk factors associated with fat necrosis were a history of chest-wall irradiation (p = 0.001), significant abdominal scar (p < 0.01), and obesity (p < 0.02). Among unipedicle reconstructions, patients with multiple risk factors had three times the incidence of fat necrosis (24.7 versus 8.3 percent) compared with patients with one or no risk factors (p < 0.002). Patients with multiple risk factors who had bipedicled TRAM flap reconstruction had no associated increased incidence of fat necrosis (p > 0.18). Forty-nine patients (8.8 percent) developed abdominal hernias. Risk factors associated with hernia formation included smoking at the time of surgery (p = 0.00001) and abdominal-wall repair with interposed mesh (p < 0.00001). The overall complication rate for this series was 23.7 percent (132 of 556). Risk factors associated with any complication included smoking (p < 0.002), history of chest-wall irradiation (p < 0.002), significant abdominal scar (p < 0.005), and obesity (p < 0.02). Patient selection is a fundamental determinant of successful TRAM flap breast reconstruction. Among patients with multiple risk factors, the risk of tissue loss in the reconstructed breast may be diminished by use of a bipedicled TRAM flap.
authors.affiliation: Division of Plastic, Reconstructive and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, Ga, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Watterson
authors.forename: J
authors.initials: J
authors.lastname: Bostwick
authors.forename: T R
authors.initials: TR
authors.lastname: Hester
authors.forename: J T
authors.initials: JT
authors.lastname: Bried
authors.forename: G I
authors.initials: GI
authors.lastname: Taylor
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy; D005218:Fat Necrosis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013524:Surgical Flaps / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors