Summary
The free TRAM flap is reliable, has minimal donor site morbidity, and provides consistently good results. It has therefore become our breast reconstruction method of choice for most patients. Key points for successful performance of the free TRAM flap include adequately exposing the recipient vessels, dissecting an adequate pedicle length, and making sure that the vein in the pedicle is not twisted. Only the fascia required to maintain flap viability should be harvested, and the repair of the donor site must be secure, with care taken to close the internal oblique fascia securely to the midline fascia deep to the linea alba with heavy permanent sutures. When properly executed, the free TRAM flap can provide outstanding results with a low rate of failure.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Schusterman MA, Kroll SS, Weldon ME. Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap? Plast Reconstr Surg. 1992;90:255–262.
Schusterman MA, Kroll SS, Miller MJ, et al. The free TRAM flap for breast reconstruction: a single center’s experience with 211 consecutive cases. Ann Plast Surg. 1994;32:234–242.
Hartrampf CR Jr, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg. 1982;69:216–224.
Hartrampf CR Jr, Bennett GK. Autogenous tissue reconstruction in the mastectomy patient: a critical review of 300 patients. Ann Surg. 1987;205:508–518.
Boyd JB, Taylor GI, Corlett R. The vascular territories of the superior epigastric and the deep inferior epigastric systems. Plast Reconstr Surg. 1984;73:1–14.
Kroll SS, Schusterman MA, Reece GP, et al. Choice of flap and incidence of free flap success. Plast Reconstr Surg. 1996;98:459–463.
Kroll SS, Evans GRD, Reece GP, et al. Comparison of resource costs of free and conventional TRAM flap breast reconstruction. Plast Reconstr Surg. 1996;98:74–77.
Kroll SS. Necrosis of abdominoplasty and other secondary flaps after TRAM flap breast reconstruction. Plast Reconstr Surg. 1994;94:637–643.
Kroll SS, Netscher DT. Complications of TRAM flap breast reconstruction in obese patients. Plast Reconstr Surg. 1989;86:886–892.
Ninkovic M, Anderl H, Hefel A, Schwabegger A, Wechselberger G. Internal mammary vessels: a reliable recipient system for free flaps in breast reconstruction. Br J Plast Surg. 1995;48:533–539.
Hefel A, Schwabegger A, Ninkovic M, Moriggl B, Waldenberger P. Internal mammary vessels: anatomical and clinical considerations. Br J Plast Surg. 1995;48:527–532.
Arnez ZM, Valdatta MP, Tyler MP, Planinsek F. Anatomy of internal mammary vessels and their use in free TRAM flap breast reconstruction. Br J Plast Surg. 1995;48:540–545.
Dupin CL, Allen RJ, Glass CA, Bunch R. The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: a report of 110 consecutive cases. Plast Reconstr Surg. 1996;98:685–689.
Feng LW. Recipient vessels in free-flap breast reconstruction: a study of the internal mammary and thoracodorsal vessels. Plast Reconstr Surg. 1997;99:405–416.
Clark CP, Rohrich RJ, Copit S, Pittman CE, Robinson J. An anatomic study of the internal mammary veins: clinical implications for free-tissue transfer. Plast Reconstr Surg. 1997;99:400–404.
Hartrampf CR Jr. Closure of the donor defect for breast reconstruction with rectus abdominis myocutaneous flaps (discussion). Plast Reconstr Surg. 1985;76:563.
Kroll SS, Marchi M. Comparison of strategies for preventing abdominal-wall weakness after TRAM flap breast reconstruction. Plast Reconstr Surg. 1992;89:1045–1053.
Swartz WM, Izquierdo R, Miller MJ. Implantable venous Doppler microvascular monitoring: laboratory investigation and clinical results. Plast Reconstr Surg. 1994;93:152–163.
Rights and permissions
Copyright information
© 2000 Springer-Verlag New York, Inc.
About this chapter
Cite this chapter
(2000). Free TRAM Flap. In: Breast Reconstruction with Autologous Tissue. Springer, New York, NY. https://doi.org/10.1007/0-387-21767-3_9
Download citation
DOI: https://doi.org/10.1007/0-387-21767-3_9
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-98670-8
Online ISBN: 978-0-387-21767-3
eBook Packages: Springer Book Archive