TRAM FLAP ANATOMY CORRELATED WITH A 10-YEAR CLINICAL-EXPERIENCE WITH 556 PATIENTS

This study examines the vascular anatomy of the TRAM flap and evaluate s risk factors associated with complications among 556 women who had T RAM flap breast reconstruction. Fifty-nine patients (10.6 percent) dev eloped fat necrosis involving 10 percent or more of their breast. Risk factors associated with fat necrosis were a history of chest-wall irr adiation (p = 0.001), significant abdominal scar (p < 0.01), and obesi ty (p < 0.02). Among unipedicle reconstructions, patients with multipl e risk factors had three times the incidence of fat necrosis (24.7 ver sus 8.3 percent) compared with patients with one or no risk factors (p < 0.0002). Patients with multiple risk factors who had bipedicled TRA M flap reconstruction had no associated increased incidence of fat nec rosis (p > 0.18). Forty-nine patients (8.8 percent) developed abdomina l hernias. Risk factors associated dth hernia formation included smoki ng at the time of surgery (p = 0.00001) and abdominal-wall repair with interposed mesh (p < 0.00001). The overall complication rate for this series was 23.7 percent (132 of 556). Risk factors associated with an y complication included smoking (p < 0.002), history of chest-wall irr adiation (p < 0.002), significant abdominal scar (p < 0.005), and obes ity (p < 0.02). cessful TRAM flap breast reconstruction. Among patient s with multiple risk factors, the risk of tissue loss in the reconstru cted breast may be diminished by use of a bipedicled TRAM flap. Patien t selection is a fundamental determinant of successful TRAM flap breas t reconstruction. Among patients with multiple risk factors, the risk of tissue loss in the reconstructed breast may be diminished by use of a bipedicled TRAM flap.