title: [Is there a psychological and physiological difference between DIEP- and free TRAM-flap? A retrospective patient survey].
abstract: BACKGROUND
  The DIEP- (Deep Inferior Epigastric Perforator) flap and the free TRAM- (Transverser Rectus Abdominis Musculocutaneous) flap are common procedures for breast reconstruction. The aim of the study was to identify a difference in the psychological and physiological patient satisfaction between DIEP- and free TRAM-flap.
  
  
  METHODS
  To provide a homogenous group, with a stable result of the reconstruction, the collective for questioning was picked out of the years 2009 and 2010. All patients included underwent a breast reconstruction with a DIEP-flap or free TRAM-flap at our division. For evaluation we formed 2 groups: DIEP-flap group (DLG) and TRAM-flap group (TLG). After preparing the questionnaire a telephone survey was performed. For the null hypothesis we postulated that there is no difference between DLG and TLG in the patient satisfaction.
  
  
  RESULTS
  We contacted 44 patients, 30 of them took part in our survey (15 from the DLG and 15 from the TLG). The mean BMI in the questionnaire group was 26.9 kg/m² and the mean age was 48.3 years. 2 questions (lifting heavy loads (p=0.005) and performing sit-up's (p=0.001)) show a significant difference between DLG and TLG, a benefit of the DLG could be seen. Both questions had the physiology of the rectus abdominis muscle as background. The complication rate for partial flap loss or partial necrosis was one third lower (p=0.299) in the TLG than compared to the DLG.
  
  
  CONCLUSIONS
  Up to now, physicians think that the DIEP-flap seems to be the best possible procedure for breast reconstruction with belly flaps. However, numerous studies disprove the superiority in the donor site morbidity. In the literature, an advantage of the TRAM-flap is clearly visible by comparing the complication rates. Our oral interviewing also states that there is no -difference in the psychological and physiological satisfaction of the patients. We can recommend a precise patient selection if a DIEP-flap for breast reconstruction should be performed. In case of comorbidities the possibility of the safer free TRAM-flap should be considered. In the future, a comparative analysis between the DIEP-flap, free TRAM-flap and pedicled TRAM-flap should be performed, by keeping the patients satisfaction, the complication rate and the cost effectiveness in mind.
authors.affiliation: Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich.
authors.forename: P
authors.initials: P
authors.lastname: Wurzer
authors.affiliation: Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich.
authors.forename: S
authors.initials: S
authors.lastname: Spendel
authors.affiliation: Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich.
authors.forename: L P
authors.initials: LP
authors.lastname: Kamolz
authors.affiliation: Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich.
authors.forename: D
authors.initials: D
authors.lastname: Parvizi
authors.affiliation: Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich.
authors.forename: A
authors.initials: A
authors.lastname: Tuca
authors.affiliation: Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik Klinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich.
authors.forename: T
authors.initials: T
authors.lastname: Rappl
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D019074:Epigastric Arteries / Q000601:surgery; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007407:Interviews as Topic; D016462:Mammaplasty / Q000379:methods* / Q000523:psychology*; D008866:Microsurgery / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000601:surgery*; D017060:Patient Satisfaction; D061525:Perforator Flap / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D013524:Surgical Flaps / Q000601:surgery*; D011795:Surveys and Questionnaires