title: Unexpected vascular compromise in transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction: a report of two patients.
abstract: Although the vascular anatomy of the transverse rectus abdominis musculocutaneous flap has been well described, poor flap perfusion can lead to partial or total flap ischemia. To minimize the potential for flap loss, criteria have been developed to identify those patients who are deemed to be high risk. Some of these high-risk patients include smokers and those with previous abdominal surgery, obesity, and/or poor medical health. Despite our diligence in patient and operative selection, 2 patients with no preexisting risk factors have recently had venous congestion of their transverse rectus abdominis musculocutaneous flap, necessitating a delayed procedure. The cases are presented here and the potential etiology for this venous congestion explored.
authors.affiliation: Division of Plastic Surgery, University of California San Diego, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Wallace
authors.forename: G R
authors.initials: GR
authors.lastname: Evans
authors.forename: D P
authors.initials: DP
authors.lastname: Goldberg
authors.forename: B J
authors.initials: BJ
authors.lastname: Baldwin
mesh_terms: D001940:Breast / Q000098:blood supply*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015411:Mastectomy, Modified Radical / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D012039:Regional Blood Flow / Q000502:physiology; D012086:Reoperation; D013524:Surgical Flaps / Q000379:methods* / Q000502:physiology; D014689:Venous Insufficiency / Q000473:pathology / Q000601:surgery*