BREAST RECONSTRUCTION USING TRAM FLAP: PROSPECTIVE OUTCOME AND COMPLICATIONS

The transverse rectus abdominis musculocutaneous (TRAM) flapremains the gold standard for postmastectomy reconstruction either immediate ordelayed. However, transfer of TRAM flap can be associated with donor sitemorbidities and complications in flap. A successful reconstruction consists of carefulpatient selection, surgical technique and meticulous preoperative planning. This studywas designed to evaluate outcome and complications of breast reconstruction withTRAM flap in association with patient conditions and risk factors, prospectively. Breast reconstruction was performed in 44 women consecutively, using the TRAM flap during a 3-year period, 1999–2002. Modified radical mastectomyaccompanying immediate reconstructions with TRAM flap was performed for 12 patients and delayed reconstruction was used for other patients with previous mastectomy. The mean age of the patients was 40.41±4.43 years. Thirty (68.18%)patients had comorbidities, consisting of radiation therapy, obesity, hypertension, diabetes mellitus, smoking and abdominal scar. Contralateral and ipsilateral TRAMflaps were used in 26(59.09%) and 14(31.81%) reconstructions, respectively. Theabdominal defect was repaired in layers with the use of synthetic mesh in 30(68.18%)patients. The overall complication rate was 31.82%, such as fat necrosis (15.91%),partial flap loss (13.64%), etc. Satisfaction rates were excellent in 10 (22.72%), goodin 25 (56.82%), moderate in five (11.36%), and poor in four (9.09%) patients. Themean of postoperative inpatient hospital days were 15.18±4.89 and 14.28±6.52 inpatients with contralateral and ipsilateral flaps, respectively (p>0.05). A significantassociation was observed between overall complications and comorbidities. Partialflap loss and fat necrosis was associated with smoking, and abdominal hernia wasassociated with obesity marginally