title: Comparison of donor-site complications and functional outcomes in free muscle-sparing TRAM flap and free DIEP flap breast reconstruction.
abstract: BACKGROUND
  One presumed advantage of the free deep inferior epigastric perforator (DIEP) flap over the free muscle-sparing transverse rectus abdominis myocutaneous (TRAM) flap is decreased donor-site morbidity. The purpose of this study was to compare the donor-site morbidity and functional outcomes in women who underwent free muscle-sparing TRAM flap or free DIEP flap breast reconstruction.
  
  
  METHODS
  All patients who underwent breast reconstruction using a free muscle-sparing TRAM flap or a free DIEP flap performed by the two senior authors at the M. D. Anderson Cancer Center between 1999 and 2003 were included in the study. The authors conducted a chart review to obtain demographic data and information regarding flap-related complications and donor-site complications. Each living patient was sent a 12-item questionnaire to elicit her perceptions about donor-site outcomes.
  
  
  RESULTS
  One hundred sixty-four patient charts were reviewed (203 flaps). Muscle-sparing TRAM flaps were used in 124 patients (98 unilateral and 26 bilateral). DIEP flaps were used in 35 patients (27 unilateral and eight bilateral). In five bilateral breast reconstructions, a muscle-sparing TRAM flap was used for one side and a DIEP flap was used for the other side. There was no significant difference in flap-related complications or donor-site morbidity between the free muscle-sparing TRAM and free DIEP flaps. Eighty-nine of 159 patients (56 percent) responded to the questionnaire; results showed no significant difference in patient-perceived abdominal function after free muscle-sparing TRAM flaps and free DIEP flaps.
  
  
  CONCLUSIONS
  In the authors' experience, there is no significant difference in flap-related complications or donor-site morbidity between the free muscle-sparing TRAM flap and the free DIEP flap. Thus, the authors advocate using the most expeditious and reliable flap based on the vascular anatomy of the DIEP system.
authors.affiliation: Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Anureet K
authors.initials: AK
authors.lastname: Bajaj
authors.forename: Pierre M
authors.initials: PM
authors.lastname: Chevray
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome