The extended use of the transverse abdominal skin (tras) flap, anatomical and clinical considerations

Abstract

The transverse thoraco-abdominal skin flap, originally described by Baroudi et al. [1], was used for closure of postmastectomy chest defects after radical mastectomy. Some modifications to the original flap have been made which add to its reliability. These mainly consist of the preservation of musculo-cutaneous perforators on both the ipsi- and contralateral sides of the pedicle, and leaving the umbilicus intact. This flap may also be used for reconstruction of groin defects. The blood supply to the TRAS flap was investigated in six fresh cadavers. Following the raising of six TRAS flaps the contralateral superior and inferior deep epigastric arteries (epigastric arcade) were cannulated and injected with microfil. The flap specimens including their pedicles were then detached and x-rayed by mammography. Complete filling of the medial half of the flaps was observed in most of the specimens indicating anastomosis of blood vessels across the midline. Since the contralateral penetration of the microfil was not observed in larger blood vessels, it is assumed that the musculo-cutaneous perforators are the main conduit for this blood supply. Beyond the reach of the contrast material the flap “borrows” its vasculature from the pre-existent subcutaneous network on the random flap principle. Three case reports are presented, in which one supra-and two infra-umbilical TRAS flaps were employed.