HEMODYNAMIC ANALYSIS OF THE TRAM - APPLICATIONS TO THE RECHARGED TRAMFLAP

The clinical observation that a free TRAM hemiflap can survive when it s vascular pedicle is anastomosed to the deep inferior epigastric vess els of a superiorly based TRAM hemiflap prompted the application of th e same principle to improve the vascularity of the contralateral ''ran dom'' portion of pedicled TRAM flaps. In 12 patients undergoing pedicl ed TRAM flap breast reconstruction, who were considered at risk for pa rtial flap necrosis, the deep inferior epigastric vessels of the carri er rectus muscle were anastomosed to the contralateral deep inferior e pigastric vessels harvested along with a small muscle plug containing three to five perforating vessels to the overlying skin island. A vasc ular arcade that joined the two sides of the flap was, thus, created, producing the following hemodynamic changes in the contralateral, prev iously ''random'' portion of the flap: (1) Direct arterial flow is sup plied by the perforators coming from the underlying muscle plug; (2) V enous outflow follows the main and most favorable route to the ipsilat eral deep venous system; and (3) The deep fat layer below the Scarpa's fascia, which is independent of the superficial vascular system, is c onnected directly to the deep system.