Elevating the island: The simplest method of delaying the TRAM flap

Vascular compromise is a relatively frequent complication of breast reconst ruction performed with the use of pedicled transverse rectus abdominis musc ulocutaneous (TRAM) flaps. The authors present their experience in delaying TRAM flaps by preelevating the island 7 to 10 days before flap transfer. T he skin island is fully incised and raised from the lateral tip to the late ral border of the rectus muscle on one side, and is raised from the tip to the midline on the opposite side. The inferior epigastric pedicle of the re ctus muscle remains intact. This method was used in 55 patients. No total f lap loss, and only two cases (3.6%) of partial flap necrosis were observed. Preelevating the island is a very simple and effective method of TRAM flap delay, alternative to the ligation of the inferior epigastric pedicle.