Treatment of difficult TRAM flap hernias using intraperitoneal synthetic mesh application

The authors report the successful repair of large lower abdominal hernia de fects after transverse rectus abdominis muscle (TRAM) flap breast reconstru ction in 11 patients using a technique of intraperitoneal application of sy nthetic polypropylene (Prolene) mesh anchored to the peritoneal surface of the abdominal wall tissues. Five of these patients had previously failed he rnia repairs after a unipedicle TRAM flap breast reconstruction employing t he onlay mesh technique, with two of the patients having undergone three pr evious hernia repairs. The other six patients had developed large hernias a fter bipedicle TRAM flap reconstruction without previous mesh supplementati on of the abdominal wall repair. After their successful hernia repairs, all of the patients healed without difficulty and demonstrated no sign of recu rrence in an 8 to 36-month follow-up. Each patient returned to her activity level before breast reconstruction.