Rp. Jewell et Tm. Whitney, TRAM fat necrosis in a young surgeon's practice: Is it experience, technique, or blood flow?, ANN PL SURG, 42(4), 1999, pp. 424-427
Fat necrosis, the most common postoperative complication in transverse rect
us abdominis musculocutaneous (TRAM) flap breast reconstruction, affects 12
% to 35% of patients. Despite its common occurrence, few studies have comme
nted on the location within the reconstructed breast. Struck by the recurre
nt appearance of fat necrosis in the medial breast mound, the authors revie
wed retrospectively 50 consecutive single-side TRAM flaps performed by the
same surgeon during his first 5 years in practice to evaluate location, fre
quency, and severity of fat necrosis, as well as technique (pedicled vs. fr
ee), inset method, and patient risk factors. Fat necrosis of any amount was
seen in 17 of 50 patients (34%). Significant fat necrosis (>5 cm) and/or i
schemic partial flap loss occurred in 11 of 50 patients (22%), appearing in
9 of 30 pedicled flaps and 2 of 20 free TRAM flaps (pedicled vs. free; p<0
.05). Fifteen of 17 ischemic areas occurred within the medial (zone II) por
tion of the flap. Preoperative obesity (>125% ideal body weight) correlated
strongly with fat necrosis (p<0.009), whereas smoking and cup size did not
. The authors' review has prompted the preferential use of free TRAM in obe
se patients, and has caused them to consider zone II to be less reliable th
an previously appreciated.