Donor site morbidity after rectus abdominis muscle flaps

Abstract

Twenty-three patients with 25 rectus abdominis muscle flaps are presented and the donor site morbidity is discussed. There was no flap loss. Donor site morbidity included two hernias after bilateral free TRAM flaps and one abdominal bulging after a free rectus muscle flap. A literature review reveals the latter to be under 10% with no difference between pedicled and free TRAM or free rectus muscle flaps; synthetic mesh offers no advantage. Abdominal strength decreases significantly after bilateral pedicled TRAM flaps, but to a lesser degree after unilateral cases when tested functionally. However, most patients are not handicapped in normal life. Pregnancy after TRAM flaps does not necessarily place the abdominal wall at risk. Age has no effect on complications but obesity does have a minor affect on abdominal wall morbidity. The free TRAM flap is better than the pedicled TRAM with regards to post-abdominoplasty necrosis, duration of hospitalization and return to baseline functional status. Skin edge necrosis, umbilical necrosis, infection and hematoma occur in 1–5% of cases. Smoking increases the risk of skin and umbilical necrosis, more so in pedicled TRAM flaps.