SEQUELAE IN THE ABDOMINAL-WALL AFTER PEDICLED OR FREE TRAM FLAP SURGERY

Twenty-seven free transverse rectus abdominis musculocutaneous (TRAM) and 16 pedicled TRAM flap breast reconstruction patients were studied for 7 to 41 months (mean, 23 months) postoperatively to compare abdomi nal sequelae after these two operations. The patient groups were demog raphically similar; mean age was 47 years in both groups. Subjective g rading of the results was similar in both groups. The incidence of min or lower abdominal bulges was higher (44%, 7/16) in the pedicled group than in the free TRAM flap group (4%, 1/27). No hernias were found. B elayed healing of the abdominal scar occurred in 3 free TRAM flap and 1 pedicled TRAM flap patients. Two free TRAM flap (8%) and 7 pedicled TRAM (44%) flap patients had minor edge necrosis of the breast. Trunk strength was tested using an isokinetic device (Lido Multi Joint II), and peak torque for flexion (mean, 111 Nm +/- 25 Nm in the free TRAM f lap group and 123 Nm +/- 28 Nm in the pedicled TRAM flap group) and ex tension (mean, 144 Nm +/- 38 Nm and 167 Nm +/- 45 Nm) were measured. N o statistical differences occurred between these groups. Sit-up perfor mance was tested and graded from 1 to 6. Both groups performed equally (4.8 and 4.8) and within normal values for this age group. Ultrasonog raphy of the rectus muscles revealed that in the free TRAM flap group, the rectus muscle of the operated side was significantly thinner (cra nial segment 6.8 mm vs. 7.8 mm, p < 0.05), thus the harvesting of a se gment of muscle below the umbilicus seems to disturb the quality of th e entire muscle. The mean size of the muscular defect in the free TRAM flap group was 4.3 x 6.1 cm. In this study no differences in patient satisfaction or trunk strength could be found between free and pedicle d TRAM flap patients.