MICROVASCULAR AUGMENTATION OF THE BLOOD-SUPPLY OF THE CONTRALATERAL SIDE OF THE FREE TRANSVERSE RECTUS-ABDOMINIS MUSCULOCUTANEOUS FLAP

The free transverse rectus abdominis musculocutaneous (TRAM) flap is a recognized, reliable method of breast reconstruction after mastectomy . However, blood supply to the contralateral side of both the free and pedicled TRAM flap, especially in zone four, is often precarious. In patients with previous midline abdominal scars or with significant rec tus divarication, both zones three and four are at risk of necrosis. V arious techniques have been described to improve the reliability of th e blood supply to the contralateral tissue in the pedicled TRAM flap, including prior delay and microvascular supplementation. We describe a new technique for augmentation of the blood supply of the contralater al side by microvascular anastomosis of the distal end of the ipsilate ral deep inferior epigastric vessels to a contralateral periumbilical perforator of the opposite side. This technique produces reliable surv ival of contralateral tissue in zones three and four, even in the pres ence of midline scars, with minimal damage to the contralateral rectus muscle. The technique is also beneficial where large bulk of tissue i s needed, such as in radical mastectomy patients, or when abdominal ti ssue is thin but the normal breast is large. Five patients in a series of 50 free TRAM flaps have been treated with the technique and the re sults are compared with other techniques.