RETROGRADE MICROVASCULAR AUGMENTATION (TURBOCHARGING) OF A SINGLE-PEDICLE TRAM FLAP THROUGH A DEEP INFERIOR EPIGASTRIC ARTERIAL AND VENOUS LOOP

Modern trends in breast reconstruction with the TRAM flap have promote d adequate blood supply to the flap while minimizing the donor-site de fect in the anterior abdominal wall. Preservation of the rectus abdomi nis muscle (both unipedicled and bipedicled), supercharg ing, delayed, and free-flap techniques all have promoted these principles. A new te chnique is presented utilizing the single pedicle with a transmidline retrograde microvascular loop anastomosis of the deep inferior epigast ric artery and vein. The turbocharging allows increased blood flow to the remote areas of the flap as well as augmented venous outflow In ad dition, the abdominal-wall donor site is similar to that of a single p edicle. This technique is ideal for reconstruction where the entire fl ap is required, a lower abdominal scar is present, or the recipient ve ssels for the free flap are absent or damaged.