Complications of Unipedicled TRAM Flap Reconstruction: Treatment and Prevention (and Their Influence on the Choice of the Reconstruction)

Abstract

Breast reconstruction with a unipedicled transverse rectus abdominis myocutaneous (TRAM) flap, originally developed by Carl Hartrampf, is a breast reconstruction procedure that is widely used because it allows a final reconstruction without a prosthesis with a natural result and is stable over time. There are two specific complications: skin fatty tissue necrosis and parietal complications such as hernias or bulges, for which there are measures to take and adapted treatments. To reduce the risk of necrosis, the bipedicled TRAM flap and the TRAM flap with strengthening of the vasculature by microsurgical techniques (supercharged TRAM flap and free TRAM flap) have been proposed. To reduce parietal complications , microsurgical techniques with preservation of the rectus abdominis muscle (deep inferior epigastric perforator flap and superficial inferior epigastric artery flap) have appeared. In our experience of the unipedicled TRAM flap, careful selection of patients, a delayed procedure, and meticulous repair of the abdominal wall are preventive measures for these complications. As a result, the rate of complications has been significantly reduced, strengthening the indication for the unipedicled TRAM flap compared with other TRAM flap techniques.