Preoperative planning of unilateral breast reconstruction with pedicled transverse rectus abdominis myocutaneous (TRAM) flaps: a pilot study of perforator mapping

Abstract

Background: Pedicled transverse rectus abdominis myocutaneous (TRAM) flaps are well-established autologous reconstructive options for breast reconstruction. Preoperative computed tomographic angiography (CTA) has since become part of the routine workup in breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. CTA provides an improved understanding of perforator anatomy which can facilitate optimal choice of hemiabdominal wall, and guide sheath harvest. Despite this knowledge, the role of preoperative CTA for breast reconstruction with the pedicled TRAM flap has not yet been established. Methods: A consecutive cohort of patients undergoing breast reconstruction with pedicled TRAM flaps without preoperative imaging were compared to a similar cohort of consecutive patients undergoing the same procedure with the use of preoperative CTA. Both flap and donor outcomes were assessed.Results: Thirty-four consecutive patients undergoing ipsilateral breast reconstruction with pedicled TRAM flaps were included. There was no statistical difference in the operative times or outcomes between the two groups. There were no complete flap losses in either group. Conclusions:The use of preoperative CTA may help to guide surgical technique and provide the surgeon with greater confidence intraoperatively, however, this study did not show significant change in operative outcomes. Further study and risk/benefit analysis may better highlight the role of CTA in pedicled TRAM flap planning.

Pedicled myocutaneous flap transplantation for a large chest wall defect with infection in a 72-year-old female

“…Subsequent multiple debridements led to the atrophy or necrosis of the adjacent pectoralis major muscle and its nearby tissues. Typically, for effectively repairing extensive chest wall defects, myocutaneous flaps situated anatomically nearby with a rich blood supply are preferred, including options like the transverse rectus abdominis myocutaneous (TRAM) flap or the latissimus dorsi myocutaneous flap [ 18 ]. Generally, autologous material is favored for chest wall soft tissue reconstruction owing to its compatibility, ease of procurement, and reliable results in reconstruction [ [19] , [20] , [21] , [22] ].…”