title: The free transverse rectus abdominis musculocutaneous flap for breast reconstruction: one center's experience with 211 consecutive cases.
abstract: All patients undergoing breast reconstruction with free transverse rectus abdominis musculocutaneous (TRAM) flaps from February 1989 to November 1992 were registered into a computerized database and followed prospectively. There were 211 free TRAM flap breast reconstructions in 163 patients; 48 reconstructions were bilateral. A muscle split technique was used in 108 of 211 reconstructions (51%). Total flap loss occurred in 3 of 211 reconstructions for a success rate of 99%. Complications occurred in 81 of 211 reconstructions (38%). Fat necrosis or partial flap loss occurred in 15 of 211 (7%). Hernia or bulge occurred in 11 patients (5%). The bulge/hernia rate tended to be lower in the muscle split group (4 of 108 [4%]) than in those who did not have muscle split procedures (7 of 103 [7%]), whereas the fat necrosis rate was slightly higher in the former group (9 of 108 [8%]) than in the latter (6 of 103 [6%]). Neither difference was statistically significant. However, patients who currently or previously smoked cigarettes did have a significantly higher incidence of fat necrosis: 12 of 99 smokers (12%) had fat necrosis compared with 3 of 112 nonsmokers (3%; p = 0.02).
authors.affiliation: Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
authors.forename: M A
authors.initials: MA
authors.lastname: Schusterman
authors.forename: S S
authors.initials: SS
authors.lastname: Kroll
authors.forename: M J
authors.initials: MJ
authors.lastname: Miller
authors.forename: G P
authors.initials: GP
authors.lastname: Reece
authors.forename: B J
authors.initials: BJ
authors.lastname: Baldwin
authors.forename: G L
authors.initials: GL
authors.lastname: Robb
authors.forename: C S
authors.initials: CS
authors.lastname: Altmyer
authors.forename: F C
authors.initials: FC
authors.lastname: Ames
authors.forename: S E
authors.initials: SE
authors.lastname: Singletary
authors.forename: M I
authors.initials: MI
authors.lastname: Ross
mesh_terms: D000328:Adult; D005218:Fat Necrosis; D005260:Female; D006555:Hernia, Ventral; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000637:transplantation*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps