Dermal autografts for fascial repair after TRAM flap harvest

To find an alternative to synthetic mesh closure of abdominal fascial defec ts after transverse rectus abdominis musculocutaneous (TRAM) flap harvest, dermal autografts were removed from tissue to be discarded and used for fas cial closure. Dermal grafts have been used for herniorrhaphy and fascial re pair after TRAM harvest previously, but have never been systematically stud ied. The dermal autograft technique was used in 24 patients to repair or re inforce anterior rectus sheath or external oblique fascia after TRAM harves t for breast reconstruction. During the same period, 25 other patients unde rwent TRAM breast reconstruction with abdominal wall closure by other metho ds. All patients were followed by serial physical examinations given by the operating surgeon. Average follow-up in the dermal autograft group was 12. 6 versus 12.0 months in the second group. In the dermal autograft group, tr ue patients complained of bulging of the anterior abdominal wall; one devel oped a true hernia, away from the location of the dermal autograft. In the second group, two patients experienced bulging. Wounds and infectious compl ications were similar in both groups. Dermal autografts are a useful altern ative to mesh repair or direct closure of fascial defects after TRAM flap h arvest.