title: The extraperitoneal laparoscopic TRAM flap delay procedure: an alternative approach.
abstract: BACKGROUND
  Ligation of the deep inferior epigastric vessels prior to transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction (delay procedure) was introduced to augment vascularity to the island flap through improved superior epigastric flow, thus decreasing flap morbidity. There are various surgical approaches described, including open and laparoscopic approaches, for ligation of inferior epigastric arteries. We describe an extraperitoneal laparoscopic technique (EPLT) and the outcomes of the procedure.
  
  
  METHODS
  All patients who underwent EPLT prior to TRAM flap construction between July 2006 and December 2008 were included in the study. Data were analyzed retrospectively from a prospectively collected database.
  
  
  RESULTS
  The study group included 11 female patients with mean age of 55 years and mean body mass index (BMI) of 34.4 kg/m(2). There were no conversions to open procedure. Ten patients had bilateral ligation of inferior epigastric arteries, and one patient had it only on one side. There were no complications related to the procedure.
  
  
  CONCLUSIONS
  Extraperitoneal laparoscopic technique as a delay procedure for TRAM flap reconstruction is safe and feasible with no morbidity related to surgery.
authors: Department of Surgery, Michigan State University, Lansing, MI 48912, USA. panduranga.yenumula@hc.msu.edu
authors: Panduranga
authors: P
authors: Yenumula
authors: Erick F
authors: EF
authors: Rivas
authors: Keith M
authors: KM
authors: Cavaness
authors: Ed
authors: E
authors: Kang
authors: Edward
authors: E
authors: Lanigan
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D019074:Epigastric Arteries / Q000502:physiology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000379:methods; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D017568:Rectus Abdominis / Q000098:blood supply / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome