THE PRECONDITIONED TRAM FLAP - PRELIMINARY CLINICAL-EXPERIENCE

The single-pedicled transverse rectus abdominis musculocutaneous (TRAM ) flap is prone to partial flap loss and fat necrosis, especially in h igh-risk groups such as patients who smoke, irradiated patients, and o bese patients. Possible methods to increase the reliability of the TRA M flap include the free TRAM, the double-pedicled TRAM, and the surgic ally delayed TRAM. When we traveled overseas to an underserved area we were largely unable to implement these options due to limitations in equipment, supplies, and the length of our trip. We encountered a comb ined fat necrosis and partial flap failure rate of 27% (3 of 11 patien ts) in a group of heavily irradiated patients. On subsequent trips we employed a technique of acute ischemic preconditioning of the TRAM fla p in 5 high-risk patients and 1 low-risk patient with good results. Al though this preliminary experience is too small to draw conclusions ab out clinical efficacy, it does demonstrate the feasibility of performi ng ischemic preconditioning in a musculocutaneous flap in a clinical s ituation.