The use of pedicled transverse rectus abdominis myocutaneous (TRAM) flap to cover large post-mastectomy defects

Coverage of the skin and soft tissue defects after mastectomy may constitute a significant problem. Although there are several options, none of them is ideal. Pedicled transverse rectus abdominis musculocutaneous flap (TRAM) has been criticized for its high complication rate of flap necrosis and fat necrosis. In this study we analysed the results of pedicled contra lateral TRAM flap used in 13 patients with breast cancer in whom primary closure of skin defects was impossible. Only one patient developed partial flap necrosis, none developed complete necrosis or fat necrosis. The results of this study were favourably influenced by good selection criteria, measures against hypothermia, conservative policy of blood transfusion. Excision of fat deep to Scarpa's fascia in zone 3 is thought to be essential in preventing partial flap necrosis and fat necrosis. In conclusion, pedicled contra lateral TRAM flap is a reliable method for coverage of large mastectomy skin and soft tissue defects.