TIMING, MAGNITUDE, AND UTILITY OF SURGICAL DELAY IN THE TRAM FLAP .2.CLINICAL-STUDIES

Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruc tion was performed in 15 patients 1 week after a preliminary delay pro cedure. The indications for surgical delay were obesity, smoking, prio r radiation therapy, a requirement for large volumes of transmidline t issue, or combinations of these risk factors. The delay procedure cons isted of outpatient ligation of the deep and superficial inferior epig astric vessels. Prior to and 1 week following the delay procedure, non invasive Doppler examinations of the superior epigastric vessels were performed. Following the delay procedure, the diameter of the superior epigastric artery increased from 1.3 +/- 0.2 to 1.8 +/- 0.3 mm (p < 0 .001) and the calculated superior epigastric artery flaw increased fro m 7.25 +/- 0.8 to 18.2 +/- 2.7 ml/min (p < 0.001). Breast reconstructi on in these high-risk patients was successful without major ischemic c omplications, but a tendency toward unreliability of zone IV was noted . This clinical observation is consistent with the findings in our ani mal studies (part I). The preliminary delay procedure was well tolerat ed with minimal morbidity. We feel that a preliminary delay procedure is a very useful option for breast reconstruction patients at high ris k for TRAM nap vascular compromise.