TRAM FLAP VASCULAR DELAY FOR HIGH-RISK BREAST RECONSTRUCTION

The purpose of this study was to evaluate the intraoperative changes i n physiologic blood pressure following vascular delay of the TRAM flap . Ligation of the superficial and deep inferior epigastric vessels 2 w eeks prior to the TRAM flap was performed. The incidence of fat necros is was 4.3 percent in 23 high-risk patients who underwent 30 immediate breast reconstructions. Direct measurement of blood pressure in the d eep inferior epigastric artery and vein was performed in a control gro up without delay consisting of 13 low-risk patients and in the study g roup of 7 high-risk patients who underwent vascular delay. Changes in TRAM flap perfusion pressure were examined following the change in loc ation of the flap from the abdomen to the chest. Blood pressure measur ements demonstrated that arterial pressure in the proximal stump of th e deep inferior epigastric artery was 64 percent in the study group pr ior to delay and 72 percent in the control group. The physiologic resp onse to vascular delay included an overall increase in arterial pressu re with a decrease in venous congestion. TRAM flap perfusion pressure was significantly increased from 13.3 mmHg (control) to 40.3 mmHg (del ayed) in the region of the midrectus perforators (p < 0.05). These dat a suggest that the technique of TRAM flap delay may increase the relia ble tissue volume and improve the safety of the TRAM flap.