Abstract
Although the free transverse rectus abdominis musculocutaneous (TRAM) flap provides for excellent breast reconstruction, it is not available to all surgeons for many reasons. The delayed unipedicled TRAM flap, based on the deep superior epigastric (DSEA) vessels, however, is a simple technique that caters to everyone. The superficial (SIEA) and deep inferior epigastric (DIEA) vessels are ligated via a lower transverse incision 1 week before the definitive transfer. The delayed flap is used when a skin paddle is required, which extends for more than several centimeters beyond the underlying rectus muscle on the ipsilateral side. It provides a flap with viability similar to the free TRAM flap based on the DIEA stem.
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