title: Is it possible to increase the survival of the transverse rectus abdominis musculocutaneous flap following previous abdominoplasty using a delay procedure? An experimental study in the rat.
abstract: BACKGROUND
  Although, because of the disruption of perforators, abdominoplasty has been suggested as a major contraindication for patients undergoing autologous breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap, many researchers encourage the search for a means of improving the survival of the skin paddle of the flap in patients who have undergone previous abdominoplasty. In this study, the effect of the surgical delay phenomenon on the survival of the TRAM flap following abdominoplasty was investigated.
  
  
  METHODS
  Thirty adult Wistar rats were used: the control group (n = 6), the short-term group (n = 12), and the long-term group (n = 12). In the control group, a standard superior pedicled TRAM flap was harvested with no abdominoplasty procedure, and the flap was replaced in situ. In all other animals, an abdominoplasty procedure was performed initially. The short-term and long-term groups were divided into two subgroups: the abdominoplasty plus TRAM-only subgroup (n = 6), and the abdominoplasty plus delay plus TRAM subgroup (n = 6). In the short-term group, the experiment was performed 1 month after abdominoplasty, whereas the same surgical procedures were applied 6 months after abdominoplasty in the long-term group.
  
  
  RESULTS
  The short-term abdominoplasty plus TRAM subgroup, the long-term abdominoplasty plus TRAM subgroup, the short-term abdominoplasty plus delay plus TRAM subgroup, the long-term abdominoplasty plus delay plus TRAM subgroup, and the conventional superior pedicled TRAM flap group showed 2.33 +/- 3.01 percent, 13.33 +/- 8.76 percent, 24.17 +/- 13.57 percent, 60 +/- 8.94 percent, and 70.83 +/- 9.70 percent survival rates for the skin paddle, respectively.
  
  
  CONCLUSIONS
  The data demonstrate that surgical delay after long-term abdominoplasty can enhance the survival rate of the skin paddle of the TRAM flap.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey. omozkan@hotmail.com
authors.forename: Omer
authors.initials: O
authors.lastname: Ozkan
authors.forename: O Koray
authors.initials: OK
authors.lastname: Coskunfirat
authors.forename: H Ege
authors.initials: HE
authors.lastname: Ozgentas
authors.forename: Ilkay
authors.initials: I
authors.lastname: Yildirim
authors.forename: M Bahadir
authors.initials: MB
authors.lastname: Dikici
mesh_terms: D000005:Abdomen / Q000601:surgery; D000818:Animals; D006085:Graft Survival / Q000502:physiology; D015187:Lipectomy; D051381:Rats; D017208:Rats, Wistar; D017568:Rectus Abdominis; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply; D013997:Time Factors