The Impact of Pfannenstiel Scars on TRAM Flap Complications

Abstract

For the past two decades, the transverse rectus abdominis musculocutaneous (TRAM) flap has been a mainstay of postmastectomy breast reconstruction. Because the flap depends on musculocutaneous perforating vessels from the rectus muscle for survival, some authors have raised concerns about increased risks of TRAM flap loss in patients with scars from previous abdominal surgeries, particularly those with Pfannenstiel scars. To assess the effects of Pfannenstiel scars on complication rates, we retrospectively evaluated the inpatient and outpatient records of 241 patients undergoing TRAM reconstruction in a single institution over an 11-year period. Of these patients, 51 had previous Pfannenstiel scars. while 190 did not. Controlling for potential confounding variables (body mass index and timing of reconstruction), logistic regressions found no significant differences between the Pfannenstiel and nonPfannenstiel cohorts in the rate of flap loss (15.7% and 20%, respectively; P = 0.376) or in the incidence of postoperative abdominal donor site laxity (17.6% and 12.1%, respectively; P= 0.361). Within the Pfannenstiel group, the type of TRAM reconstruction (ie, pedicle versus free flaps) did not have a significant effect on complication rates. We conclude that previous concerns over the impact of preexisting Pfannenstiel scars on TRAM flap complications are unfounded.

Complications and oncologic outcomes of pedicled transverse rectus abdominis myocutaneous flap in breast cancer patients

“…Our findings thus confirmed that postoperative radiotherapy did not increase the risk of flap complications. Prior abdominal incisions, such as lower transverse, lower paramedian, lower midline, or periumbilical incisions, were not related to flap complications, a result also similar those seen in previous reports (19). However, in patients with prior lower midline incision, we preferred to excise zones 2 and 4 of the TRAM flap to decrease the incidence of flap necrosis.…”

Donor-Site Complications and Remnant of Rectus Abdominis Muscle Status after Transverse Rectus Abdominis Myocutaneous Flap Reconstruction

“…Our findings show that age, underlying disease, operative time, chemotherapy, and previous abdominal surgery did not increase the risk of abdominal wall bulging and hernia. 27 …”

MOC-PSSM CME Article: Breast Reconstruction

“…35,36 Although they can compromise superficial inferior epigastric artery (SIEA) perforator flaps, transverse suprapubic cesarean section scars and Pfannenstiel incisions rarely damage the deep inferior epigastric vessels and are therefore not contraindications to DIEP or TRAM flap surgery. 37 The buttock, flank, and thigh regions should be examined regarding the potential for microsurgical transfer of superior gluteal artery perforator, inferior gluteal artery perforator, Rubens (deep circumflex iliac artery perforator), anterolateral thigh, and transverse upper gracilis flaps.…”