Supercharged pedicled TRAM flap in breast reconstruction: Is it a worthwhile procedure

A clinical study of the incidence of vascular complications in free and supercharged pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps was undertaken. The complications associated with each of these two TRAM flaps were assessed. The incidence of vascular complications in the supercharged pedicle was found to be twice that associated with the free TRAM flap (36% vs. 18%); however, these results did not reach significance (p = 0.2). Fat necrosis was the most common complication in each group, with the overall rate being 17%. The incidence in the supercharged TRAM flap (29%) was more than twice that in the free TRAM flap (13%; p = 0.2). Partial flap loss was also greater in the charged flap than in the free flap (14% vs. 3%, p = 0.1). The results, however, did not reach significance, and this may be related to the relatively small sample size (52 patients). Vein grafts were used more often in the supercharged pedicled TRAM flap (p = 0.02). Obesity was also associated more frequently with the supercharged pedicled TRAM flaps (p = 0.07). Other risk factors were nearly equally distributed between either type of the flap. The results of the study support the continued use of the free TRAM flap. There appears to be no additional advantage in charging the pedicled TRAM with a microvascular anastomosis because the results were found to be inferior to those of the free TRAM flap. Other clinical factors, however, may dictate the type of flap used. A larger series is required to assess the importance of each of the risk factors affecting flap survival.