The 3-Hour Muscle-Sparing Free TRAM Flap: Safe and Effective Treatment Review of 111 Consecutive Free TRAM Flaps in a Private Practice Setting

Abstract

The technical difficulties associated with the free TRAM flap have been ameliorated using a well-designed surgical plan and consistent technique performed by a team familiar with the procedure to achieve an acceptable average 3-hour operating time, with minimal complications. The authors advocate the muscle-sparing free TRAM flap as the operation of choice for unilateral breast reconstruction using autogenous tissue. The technique is expeditious and relatively safe.

Defining Fat Necrosis in Plastic Surgery

“…[10][11][12] In addition, many studies defined a range of time postoperatively used to detect and diagnosis fat necrosis, generally in the range of 2 to 6 months. 2,10,[12][13][14][15][16][17][18][19] The diagnosis and workup of fat necrosis also varied widely between studies. Nearly all studies initially detected areas of suspected fat necrosis by clinical examination.…”

“…There again exists a wide variation between authors on how to define and classify fat necrosis using radiology. 19,21,22,34 Parikh et al describe a classification scheme for fat grafting in breast reconstruction using ultrasonography. 22 In addition, we believe a definition and grading system with a clinical focus is more relevant when determining management of fat necrosis.…”

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.…”

Free Tissue Transfer in the Private Practice Setting: A Review of 100 Patients

“…7,16,[25][26][27] There have been several reports of the use of free tissue transfer in the community hospital setting, generally involving a small number of surgeons with the assistance of residents. 6,[28][29][30] Maffi reported an 85% success rate with 53 free flaps in 49 patients by a team consisting of one attending with a plastic surgery resident and a general surgery resident in a county hospital. 6 Olsson reported 18 free TRAM flaps in 16 patients with no flap losses.…”