THE DELAYED TRAM FLAP

As surgeons gain increased clinical experience with the transverse rec tus abdominis myocutaneous (TRAM) flap, or autologous breast reconstru ction, technical modifications aimed at improving flap reliability con tinue to evolve. These modifications have allowed the TRAM flap to be performed safely in a higher-risk patient population. The delayed TRAM flap appears to have an augmented arterial supply and a lesser degree of venous congestion following division of the deep inferior epigastr ic vessels 2 weeks prior to reconstruction. Ischemia-related complicat ions have been reduced in high-risk patients with the use of the delay ed TRAM.