INDEXES OF OBESITY AND BEHAVIOR OF THE PEDICLED TRAM FLAP IN BREAST RECONSTRUCTION

The association between obesity and the outcome of pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps was studied in 12 pati ents. Obesity was assessed preoperatively by body mass index (BMI) and waist:hip circumference ratio (WHCR). The thickness of the abdominal fat and muscles was measured preoperatively with ultrasonography on th e abdomen and during the nine postoperative months:on the flap. Margin al or fat necrosis was more common among patients with lower body type fat distribution (WHCR less than 0.80) than in patients with medium o r upper body type fat distribution. BMI and abdominal muscle and fat t hicknesses were not associated with marginal or fat necrosis of the fl aps. We conclude that lower body (female type) fat distribution may be associated with marginal cutaneous or fat necrosis in pedicled TRAM f laps.