Clinical results and color-coded Duplex sonography (CCDS) after four yearsexperience with TRAM-flap conditioning

Presented is a new technique in preoperative conditioning of the pedicled T RAM-flap employing an interventional-radiologic procedure, selective emboli zation of the deep inferior epigastric artery (DIEA). During a four year pe riod in 40 patients with a mean age of 48,4 (31-66) years breast reconstruc tion was performed by a superiorly pedicled TRAM-flap following preoperativ e conditioning. 30 of 40 patients were eligible for follow-up one to five y ears postoperatively. The mean interval between embolization and surgery am ounted to 3.6 months. In 25 of 30 cases embolization of the DIEA was perfor med bilaterally, in 5 of 30 cases unilaterally. 14 of 30 patients underwent preoperative radiotherapy for breast cancer. Applying CCDS the peak flow v alues were determined in the superior epigastric arteries (TRAM/contralater al side). Pre-embolization values (54.9cm/s/55.8 cm/s), post-embolization v alues (57.2 cm/s/ 57.9 cm/s) and late postoperative values (61.0 cm/s/61.6 cm/s) proved a statistically significant effect of selective embolization o n peak flow without relevant difference between TRAM and contralateral side (p < 0.05). Postoperative flap complications consisted of partial necrosis in 2 of 30, fat necrosis in 1 of 30, impaired wound healing in 5 of 30 and postoperative bleeding in 2 of 30 cases. Abdominal wound healing complicat ions occurred in 5 of 30 cases, abdominal wall weakness was found in 8 of 3 0 and hernia formation in 4 of 30 cases. Corrective surgery was performed a t the breast (TRAM-flap) in 22 of 30 and at the abdomen (donor site) in 9 o f 30 cases. Patient acceptance concerning selective embolization and TRAM-f lap surgery was very high. 29 of 30 patients confirmed that they would agai n choose this type of breast reconstruction. The pedicled TRAM-flap following preoperative conditioning by selective emb olization of the DIEA constitutes a safe and reliable method of breast reco nstruction with autogenous tissue. It is superior to the pedicled TRAM-flap without delay and offers definite advantages compared to alternative techn iques of enhanced flap vascularization.