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

Abstract

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.

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

“…Only a portion of the fatty layer of the flap is fed in a vertical direction from vessels derived from the subdermal and fascial vascular networks, and hence, the adipose layer might be the most peripheral site of blood circulation in the TRAM flap. 13,33,42 On the other hand, the division of the flap to different zones is probably not exactly similar in different studies.…”

Effects of Obesity on Postoperative Complications After Breast Reconstruction Using Free Muscle-Sparing Transverse Rectus Abdominis Myocutaneous, Deep Inferior Epigastric Perforator, and Superficial Inferior Epigastric Artery Flap

“…23 These studies were also included for the summarization of pooled complication rates except for 1 with fewer than 10 patients in each subgroup. The other 7 studies 9,19,30-34 (2 presenting data only for obese patients 6,9 and 5, only for nonobese patients [30][31][32][33][34] were use) for the pooled analysis (Tables 2 and 3). As a result, a total of 14 studies were suitable for the calculation of pooled complication rates for muscle-conserving abdominal flaps.…”

Quality of Life and Patient-Reported Outcomes in Breast Cancer Survivors

“…Reports have described abdominal wall hernia and bulge rates as high as 62% for p-TRAM 3 , 27% for f-TRAM 4 , 11% for msf-TRAM 5 , and 10% for DIEP flaps. 6,7 While advances in abdominal wall closure techniques may minimize hernia and bulge complications, these are unlikely to decrease abdominal wall weakness and a patient’s ability to conduct activities of daily life without discomfort. 6 Multiple studies evaluating objective abdominal wall strength with functional dynamometry have demonstrated significant differences between different types of flaps.…”

“…6,7 While advances in abdominal wall closure techniques may minimize hernia and bulge complications, these are unlikely to decrease abdominal wall weakness and a patient’s ability to conduct activities of daily life without discomfort. 6 Multiple studies evaluating objective abdominal wall strength with functional dynamometry have demonstrated significant differences between different types of flaps. 8,9,10,11,12,13 In these studies, patients with f-TRAM and p-TRAM reconstruction have been found to have more abdominal wall weakness relative to msf-TRAM and DIEP groups.…”