Autologous Blood Transfusion in TRAM Breast Reconstruction:

Abstract

Many centers continue to use preoperative donation of autologous blood as part of their reconstructive protocol for pedicled transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction, despite the lack of support for this in the English language literature. This prospective study compares 3 groups of patients undergoing reconstruction with TRAM flaps using 3 different protocols in 3 different centers. Group 1 did not donate blood preoperatively. Group 2 donated 1 to 2 U preoperatively and received their blood intraoperatively or during the early postoperative period. Group 3 did not receive their autologous blood unless they displayed symptoms of hypovolemia or anemia postoperatively. There were no statistical differences between groups in age, length of stay, or number of unilateral versus bilateral procedures. Patients who did not donate autologous blood (group 1) had statistically significantly higher preoperative and postoperative day 3 hemoglobin levels than patients in the groups that did predonate. The authors conclude that preoperative autologous donation of blood does not confer any clinical advantage to patients undergoing autologous breast reconstruction using pedicled TRAM flaps.

Assessment of immediate symmetrization in breast reconstruction

“…Smith et al 7 also showed that the complication rates (11%) and blood transfusion rates (9%) were low. The complication rate for the contralateral breast was extremely low (1%), although previous studies have shown a desire to perform these procedures simultaneously because the risk of blood loss causes an unacceptably high rate of blood transfusion [14][15][16][17][18] .…”

Predictors of Blood Transfusion in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

“…Low preoperative hemoglobin levels may be attributed to the patient's oncologic state, effects of chemotherapy, nutritional state, and the undertaking of preoperative autologous blood donation. 7,25,28,29 The practice was popularized in the 1990s in the event of reported allogenic blood transfusion-related blood-borne infections. Autologous blood transfusion has also been said to reduce hospital stay, lower complication rate, and enable an earlier return to preoperative level but may increase postoperative transfusion requirements.…”

“…In the absence of a standardized method of measuring blood loss, the incidence, rate, and volume of transfusion have been widely used as an indirect marker of perioperative blood loss. The literature reports a transfusion rate in transverse rectus abdominis myocutaneous (TRAM) flap patients averaging anywhere from 6 to 95%, [3][4][5][6][7][8][9] with Holley et al reporting a transfusion rate of 95% in both pedicled and free TRAM flaps. 10 This broad range reflects the differing policies for transfusion between units and between physicians.…”

Effect of perioperative transfusion of old red blood cells on postoperative complications after free muscle sparing transverse rectus abdominis myocutaneous flap surgery for breast reconstruction

“…A review of the literature indicated that the transfusion rate in TRAM flap patients is 6–95% . Recent studies showed that transfusion is associated with adverse clinical outcomes in free flap surgery .…”

“…14 A review of the literature indicated that the transfusion rate in TRAM flap patients is 6-95%. [15][16][17] Recent studies showed that transfusion is associated with adverse clinical outcomes in free flap surgery. [18][19][20] However, no study has investigated the effect of transfusing old blood on postoperative complications following TRAM flap surgery.…”