Comparison of Donor-Site Complications and Functional Outcomes in Free Muscle-Sparing TRAM Flap and Free DIEP Flap Breast Reconstruction

Bajaj, Anureet K.; Chevray, Pierre M.; Chang, David W.

doi:10.1097/01.prs.0000200062.97265.fb

Cited by 171 publications

(105 citation statements)

References 14 publications

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“…There was a higher rate (although not statistically significant) of muscle-sparing (MS) procedures (DIEP or MS2 flaps compared to MS0 or MS1 flaps) performed in the CTA group compared to the non-CTA group (90 vs. 67%), however with contention in the literature as to the exact classification of such procedures and indeed their benefit, it was felt that muscle-sacrifice would not be an exclusion criterion, and rather may suggest a further benefit of improved preoperative imaging. 5,25 The reason for this change in operative technique is likely to include selection of the optimal perforator(s) for inclusion in the flap and as well as selecting the side of choice for perforator dissection. A further outcome measure analyzed was length of operation.…”

Section: Discussionmentioning

confidence: 99%

Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?

et al. 2008

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“…24 When a pulsating dominant perforator was visualized and the flap could be raised sparing the rectus muscle by atraumatical dissection, a DIEP flap was preferred and included one to three perforators (n 5 9). Otherwise, a muscle-sparing free TRAM (MS-2) 25,26 was preferred (n 5 4). In this study, we used the conventional division of the flap blood perfusion zones by Hartrampf et al (Fig.…”

Section: Patients and Surgical Proceduresmentioning

confidence: 99%

Perfusion in free breast reconstruction flap zones assessed with positron emission tomography

et al. 2010

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The aim of this pilot study was to determine the postoperative blood perfusion (BF(PET)) and perfusion heterogeneity (BF(PET) HG) in free microvascular breast reconstruction flap zones with positron emission tomography (PET). Regional BF(PET) and BF(PET) HG of the adipose tissue in medial, central, and lateral parts of 13 free flaps were assessed on the first postoperative morning with PET using oxygen-15-labeled water ([(15)O]H(2)O) in 12 patients undergoing breast reconstruction with a deep inferior epigastric perforator (DIEP) or a transverse rectus abdominis muscle (TRAM) flap. The mean BF(PET) values did not differ between DIEP and TRAM flaps (P = 0.791). The mean BF(PET) values were higher in zone III compared with zone I (P = 0.024). During follow-up, fat necrosis was identified in three patients in the medial part (zone II) of the flap. However, the adipose tissue BF(PET) assessed on the first postoperative day from all zones of the flap using PET with radiowater was normal. The BF(PET) HG was higher in the control side (i.e., in the healthy breast tissue) compared with the flap (P = 0.042). The BF(PET) HG was lower in zone III than in zone I (P = 0.03) and in zone II (P < 0.001). In this pilot study, PET was used for the first time for studying the adipose tissue perfusion in different zones in free flaps in a clinical setup, finding that the mean BF(PET) values did not differ between DIEP and TRAM flaps, and that zone II was sometimes not as well perfused as zone III supporting revisited zone division.

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“…These results are the same as previous reports. 5,14 The free MS-0 TRAM flap to MS-2 flap have the same number of perforator vessels in the flap and therefore are not different in flap blood flow. In MS-3 (DIEP flap), however, the region of flap survivability differs depending on the number of perforator vessels contained in the flap and also whether the lateral or medial perforator vessels are used.…”

Section: Discussionmentioning

confidence: 99%

Muscle sparing‐2 transverse rectus abdominis musculocutaneous flap for breast reconstruction: A comparison with deep inferior epigastric perforator flap

et al. 2008

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Breast reconstruction using free transverse rectus abdominis musculocutaneous (TRAM) flap can be divided into 4 muscle-sparing (MS) types: conventional TRAM flap containing full width muscle as MS-0, while deep inferior epigastric perforator (DIEP) flap containing absolutely no muscle as MS-3. We include only the muscle portion between the medial row and lateral row perforator vessels in TRAM flap, which is designated as MS-2. Between October 1999 and April 2006, the same surgeon performed 82 breast constructions using MS-2 free TRAM flaps in 79 patients. All the flaps survived. Postoperative complications included partial fat necrosis in 8 cases, all corresponding to zone IV or zone II. Bulging of donor site occurred in 5 patients, 4 of whom were obese and 1 had bilateral flap harvest. Compared with our own reconstructions using DIEP flap (30 cases), there were no significant differences in operative time and blood loss between the two techniques. In conclusion, MS-2 free TRAM flap is a useful technique for breast construction considering the easy surgical techniques, length of the vascular pedicle that can be harvested, and the degree of freedom of the flap.

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Comparison of Donor-Site Complications and Functional Outcomes in Free Muscle-Sparing TRAM Flap and Free DIEP Flap Breast Reconstruction

Cited by 171 publications

References 14 publications

Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?

Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?

Perfusion in free breast reconstruction flap zones assessed with positron emission tomography

Muscle sparing‐2 transverse rectus abdominis musculocutaneous flap for breast reconstruction: A comparison with deep inferior epigastric perforator flap

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