Technique for Minimizing Donor-site Morbidity after Pedicled TRAM-Flap Breast Reconstruction: Outcomes by a Single Surgeon's Experience.
BACKGROUND
Breast reconstruction with pedicled transverse rectus abdominis myocutaneous (TRAM) flap can result in significant abdominal wall donor-site morbidity. We present our technique of transversely dividing the anterior fascia and rectus abdominis combined with reinforcement above the arcuate line for closure of the anterior abdominal wall defect to prevent contour deformities performed by a single senior surgeon and compare these results with those of our prior series.


METHODS
We described our new technique of closure of the abdominal wall defect and retrospectively performed the comparison between the results of pedicled TRAM flaps using the new closure technique and those of 420 pedicled TRAM flaps from our 2003 publication in terms of abdominal bulging and hernia.


RESULTS
Sixty-seven pedicled TRAM flaps in 65 patients were compared with 420 pedicled TRAM flaps of the 2003 series. The new technique was associated with 5 partial TRAM flap necroses (8%). There was no total flap loss with the new technique. The median follow-up period was 13 months (range, 4-36 months). There were no instances of abdominal hernia and bulge during follow-up in the new series. Compared with the previous 2003 series, the new technique was superior in terms of occurrence of abdominal wall hernia or bulging.


CONCLUSIONS
We are still performing pedicled TRAM flap for autologous breast reconstruction. Using the technique of transversely dividing the anterior fascia and rectus abdominis combined with reinforcement above the arcuate line can reduce the occurrence of abdominal bulging and hernia.
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Mario
M
Rietjens
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Francesca
F
De Lorenzi
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Manconi
M
Andrea
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Jean-Yves
JY
Petit
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Prakasit
P
Chirappapha
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Alaa
A
Hamza
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Stefano
S
Martella
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Benedetta
B
Barbieri
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Alessandra
A
Gottardi
Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy; and Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Lomeo
L
Giuseppe