TRANSVERSE RECTUS ABDOMINIS MYO-CUTANEOUS (TRAM) FLAP IN BREAST RECONSTRUCTION

Transverse Rectus Abdominis Myo-Cutaneous (TRAM) Flap in Breast Reconstruction The use of au-tologous tissues in breast reconstruction has significant advantages over implants and patients have high satisfaction rates in reconstructions with autologous tissue. Because the lower abdominal donor site is easily accessible and leaves easily concealable scars, breast reconstruction with abdominal tis-sues provides the most natural result with the least donor site morbidity of all techniques. With its design with a transverse skin island on the rectus abdominis muscle (TRAM Flap), it started to be used as a pedicled flap in breast reconstruction and later became popular as a TRAM flap used with a free fold. The rectus abdominis muscle has 2 separate dominant vascular pedicles. The muscle is supplied by the superior and inferior deep epigastric artery and vein with bidirectional continuity within the muscle. Rectus abdominis muscle-skin flaps can be prepared from two different pedicles. The first is the superior epigastric and the second is the deep inferior epigastric vascular pedicles. It is used in breast reconstruction as a pedicled flap with superior epigastric vessels and as a free flap with deep in-ferior epigastric vessels. In this chapter, the technical features of both flap designs are discussed. Lower abdominal flaps may not be used in very thin patients with insufficient tissue in the lower abdomen or in patients with scars or a history of abdominal surgery that may prevent the use of flaps. In addition, high BMI should be considered for both donor site healing and susceptibility to partial flap necrosis, and smoking should be considered for tissue perfusion, especially in pedicled TRAMs.