THE FREE TRANSVERSE RECTUS-ABDOMINIS MUSCULOCUTANEOUS FLAP FOR BREASTRECONSTRUCTION - ONE CENTERS EXPERIENCE WITH 211 CONSECUTIVE CASES

All patients undergoing breast reconstruction with free transverse rec tus abdominis musculocutaneous (TRAM) flaps from February 1989 to Nove mber 1992 were registered into a computerized database and followed pr ospectively. There were 211 free TRAM flap breast reconstructions in 1 63 patients; 48 reconstructions were bilateral. A muscle split techniq ue was used in 108 of 211 reconstructions (51%). Total flap loss occur red in 3 of 211 reconstructions for a success rate of 99%. Complicatio ns occurred in 81 of 21 1 reconstructions (38%). Fat necrosis or parti al flap loss occurred in 15 of 211 (7%). Hernia or bulge occurred in 1 1 patients (5%). The bulge/hernia rate tended to be lower in the muscl e split group (4 of 108 [4%]) than in those who did not have muscle sp lit procedures (7 of 103 [7%]), whereas the fat necrosis rate was slig htly higher in the former group (9 of 108 [8%]) than in the latter (6 of 103 [6%]). Neither difference was statistically significant. Howeve r, patients who currently or previously smoked cigarettes did have a s ignificantly higher incidence of fat necrosis: 12 of 99 smokers (12%) had fat necrosis compared with 3 of 112 nonsmokers (3%; p = 0.02).