DONOR SITE MORBIDITY AFTER RECTUS-ABDOMINIS MUSCLE FLAPS

Twenty-three patients with 25 rectus abdominis muscle flaps are presen ted and the donor site morbidity is discussed. There was no flap loss. Donor site morbidity included two hernias after bilateral free TRAM f laps and one abdominal bulging after a free rectus muscle flap. A lite rature review reveals the latter to be under 10% with no difference be tween pedicled and free TRAM or free rectus muscle flaps; synthetic me sh offers no advantage. Abdominal strength decreases significantly aft er bilateral pedicled TRAM flaps, but to a lesser degree after unilate ral cases when tested functionally. However, most patients are not han dicapped in normal life. Pregnancy after TRAM flaps does not necessari ly place the abdominal wall at risk. Age has no effect on complication s but obesity does have a minor affect on abdominal wall morbidity. Th e free TRAM flap is better than the pedicled TRAM with regards to post -abdominoplasty necrosis, duration of hospitalization and return to ba seline functional status. Skin edge necrosis, umbilical necrosis, infe ction and hematoma occur in 1-5% of cases. Smoking increases the risk of skin and umbilical necrosis, more so in pedicled TRAM flaps.