title: Surgical delay in TRAM flap breast reconstruction: a comparison of 7- and 14-day delay periods.
abstract: Thirty-one transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstructions were performed after a delay period either of 1 week (group I, N = 15) or 2 weeks (group II, N = 16). The preliminary delay procedure consisted of bilateral deep inferior epigastric and superficial inferior epigastric artery and vein ligation. In group I the diameter and flow in the superior epigastric artery increased from baseline values of 1.3 +/- 0.3 mm and 7.25 +/- 0.8 ml per minute to 1.8 +/- 0.3 mm and 18.2 +/- 2.7 ml per minute at 1 week. In group II the diameter and flow in the superior epigastric artery increased from baseline values of 1.2 +/- 0.3 mm and 5.85 +/- 1.5 ml per minute to 1.7 +/- 0.4 mm and 23.4 +/- 6.2 ml per minute at 2 weeks. The differences between 1 and 2 weeks were not statistically significant. The complication rate in either group was similar. We conclude that a preliminary delay procedure is highly effective at augmenting TRAM flap vascularity and may be implemented between 1 and 2 weeks prior to TRAM flap breast reconstruction in high-risk patients.
authors.affiliation: Section of Plastic Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Restifo
authors.forename: S A
authors.initials: SA
authors.lastname: Syed
authors.forename: B A
authors.initials: BA
authors.lastname: Ward
authors.forename: L M
authors.initials: LM
authors.lastname: Scoutt
authors.forename: K
authors.initials: K
authors.lastname: Taylor
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D001940:Breast / Q000098:blood supply; D019074:Epigastric Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D013524:Surgical Flaps / Q000379:methods* / Q000502:physiology; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex