Clinical results of TRAM flap delay by selective embolization of the deep inferior epigastric arteries

Preoperative selective embolization of the deep inferior epigastric arterie s constitutes a new technique in TRAM flap delay. Whereas surgical ligation of these vessels has proved to he an effective delay procedure in experime ntal and clinical settings, it requires an additional operative step under general anesthesia. Despite the introduction of the free TRAM leading to im proved flap perfusion, this microsurgical technique is not always available because of the requirements of specialized equip ment and staff longer ope rating hours, and subsequently higher expenses. The search for a minimally invasive, easy, and inexpensive technique to improve perfusion of the pedic led TRAM flap led us to selective embolization of the deep inferior epigast ric arteries by an angiographic procedure. After 4 years of experience with this technique, we now present the first clinical results. Breast reconstr uction hv a delayed pedicled TRAM nap was performed in 40 patients with a m ean age of 48.4 years (range, 31 to 66 years). The mean interval between em bolization and surgery was 3.6 months. Postoperative data concerning flap s urvival and complications were available for all patients. Embolization of the deep inferior epigastric arteries was performed bilaterally in 35 patie nts (87.5 percent) and unilaterally in 5 patients (12.5 percent). Radiother apy had been applied in 21 patients (52.5 percent) before surgery. Postoper ative flap complications consisted of partial necrosis in three (7.5 percen t), fat necrosis in one (2.5 percent), impaired wound healing in five (12.5 percent), and postoperative bleeding in two patients (5 percent). Abdomina l wound healing complications occurred in six patients (15 percent), abdomi nal wall weakness in eight (20 percent), and hernia formation in four (10 p ercent). Surgical corrections were performed at the breast (TRAM flap) in 2 2 patients (55 percent) and at the abdomen (donor site) in 9 (22.5 percent) . Preoperative selective embolization of the deep inferior epigastric arterie s constitutes an alternative delay procedure for the pedicled TRAM flap. It is superior to the conventional procedure without delay, offers several ad vantages compared with surgical ligation of these vessels. end represents a n alternative to the free TRAM flap in selected cases.