Microvascularly augmented transverse rectus abdominis myocutaneous flap for breast reconstruction--reappraisal of its value through clinical outcome assessment and intraoperative blood gas analysis.
Our experience with 73 transverse rectus abdominis myocutaneous (TRAM) flap transfers was reviewed to see the variance in the incidence of complications among three groups of patients undergoing different types of surgical techniques. The TRAM flap was transferred as a free flap in 26 patients, a unipedicled flap in 25 patients, and a microvascularly augmented pedicled flap in 22 patients. Our data demonstrated that the incidence of partial flap loss and fat necrosis in the microvascularly augmented group was significantly lower than that in the unipedicled flap group (P < 0.01), and also lower than that in the free flap group with a statistically marginal significance (P = 0.055). Supplemental surgery is less often required in the microvascularly augmented group than in the conventional TRAM group (P = 0.002). Substantial increase in venous O(2) concentration (P = 0.03), O(2) saturation level (P = 0.007), and pH value (P = 0.002) was noticed following supercharge, and this very fact testifies to the perfusion-promoting effect of the microvascular augmentation maneuver.
Section of Plastic Surgery, Department of Surgery, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan, Republic of China. jwlee@mail.ncku.edu.tw
Jing-Wei
JW
Lee
Yao-Chou
YC
Lee
Tsai-Wang
TW
Chang
D000328:Adult; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008833:Microcirculation / Q000502:physiology; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology; D011336:Probability; D017568:Rectus Abdominis / Q000098:blood supply* / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology