The "parasite" TRAM flap for autogenous tissue breast reconstruction in patients with vertical midabdominal scars

Abdominal scars play an important role in risk factors in transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction. In particula r, vertical midline scars are a difficult problem to solve. Traditional tec hniques include the use of a single hemiflap (which may be insufficient to achieve an adequate volume), the transfer of a double-pedicle flap (which c auses major trauma to the abdominal wall), or more complicated procedures s uch as two free hemiflaps. Since 1991 the authors have used an innovative t echnique to improve vascularity in the contralateral side of a standard uni pedicled TRAM flap, They call this flap the recharged TRAM flap. By means o f their technique, the retrograde flow coming from the deep inferior epigas tric vessels raised in continuity with a superiorly pedicled flap is used t o "recharge" the contralateral rectus muscle harvested as a free flap. On t he basis of hemodynamic studies, this procedure was carried out in patients with vertical midabdominal scars. This flap was named the parasite flap be cause the free unit survives on the vascular source of the pedicled unit-th e superior epigastric artery supplying both flaps in a retrograde fashion. Sixteen patients with vertical midabdominal scars underwent this procedure. Total flap survival was observed in 15 patients. One patient developed a p artial flap necrosis and 1 patient developed abdominal bulging on the pedic led side. According to the surgeons' evaluation, aesthetic outcome was considered to be good to excellent in all patients.