Intraoperative Evaluation of Flap Circulation by ICG Fluorescence Angiography in the Breast Reconstruction with Pedicled TRAM Frap

Abstract

Since its introduction, the pedicled transverse rectus abdominis myocutaneous flap (TRAM flap) became a popular procedure for postmastectomy breast reconstruction. Preference for the pedicled TRAM flap was based on its sufficient volume for reconstruction, natural appearing result, acceptable scar of the donor site, and the avoidance of complications caused by the use of implant. However, the perfusion of the pedicled TRAM flap is not as reliable as expected, because this flap has the better blood flow through the inferior epigastric vessels than through the superior epigastric vessels. In general, all the tissue in zone IV of the flap and the parts of the skin in zone II and III tend to be necrotic. When the flap is designed as larger than usual, the inferior epigastric system on the ipsilateral side is prepared for microvascular augmentation.