title: The surgically delayed unipedicled TRAM flap for breast reconstruction.
abstract: Surgical delay is one method of enhancing the vascularity of the lower abdominal transverse rectus abdominis musculocutaneous (TRAM) flap. The outcome of 7 patients who underwent surgical delay (by ligating both superficial and deep inferior epigastric vessels bilaterally) a week prior to definitive TRAM flap elevation is described. Three patients were smokers, 3 were obese, and 1 was an asthmatic on medication. A satisfactory aesthetic result was achieved in all patients and the complications that occurred were minor. Two patients developed minor skin necrosis due to inadequate trimming of zone 4 on the contralateral side to the pedicle and there were 3 cases of fat necrosis, which occurred below Scarpa's fascia. Surgical delay is a useful technique of breast reconstruction. It allows the flap to be centered safely in the lower abdomen. In the high-risk patient, delay may prevent the need for microsurgery or the sacrifice of both recti.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Groote Schuur Hospital, Cape Town, South Africa.
authors.forename: D A
authors.initials: DA
authors.lastname: Hudson
mesh_terms: D000328:Adult; D001249:Asthma / Q000503:physiopathology; D001943:Breast Neoplasms / 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; D009765:Obesity / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology; D013524:Surgical Flaps / Q000379:methods* / Q000502:physiology; D016896:Treatment Outcome