THE USE OF PEDICLED TRANSVERSE RECTUS-ABDOMINIS MYOCUTANEOUS (TRAM) FLAP TO COVER LARGE POSTMASTECTOMY DEFECTS

Coverage of the skin and soft tissue defects after mastectomy may cons titute a significant problem. Although there are several options, none of them is ideal. Pedicled transverse rectus abdominis musculocutaneo us flap (TRAM) has been criticized for its high complication rate of f lap necrosis and fat necrosis. In this study we analysed the results o f pedicled contra lateral TRAM flap used in 13 patients with breast ca ncer in whom primary closure of skin defects was impossible. Only one patient developed partial flap necrosis, none developed complete necro sis or fat necrosis. The results of this study were favourably influen ced by good selection criteria, measures against hypothermia, conserva tive policy of blood transfusion. Excision of fat deep to Scarpa's fas cia in zone 3 is thought to be essential in preventing partial flap ne crosis and fat necrosis. In conclusion, pedicled contra lateral TRAM f lap is a reliable method for coverage of large mastectomy skin and sof t tissue defects.