ABSTRACT
Background: Pedicled transverse rectus abdominis myocutaneous (TRAM) flaps are well-established autologous reconstructive options for breast reconstruction. Preoperative computed tomographic angiography (CTA) has since become part of the routine workup in breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. CTA provides an improved understanding of perforator anatomy which can facilitate optimal choice of hemiabdominal wall, and guide sheath harvest. Despite this knowledge, the role of preoperative CTA for breast reconstruction with the pedicled TRAM flap has not yet been established. Methods: A consecutive cohort of patients undergoing breast reconstruction with pedicled TRAM flaps without preoperative imaging were compared to a similar cohort of consecutive patients undergoing the same procedure with the use of preoperative CTA. Both flap and donor outcomes were assessed. Results: Thirty-four consecutive patients undergoing ipsilateral breast reconstruction with pedicled TRAM flaps were included. There was no statistical difference in the operative times or outcomes between the two groups. There were no complete flap losses in either group. Conclusions: The use of preoperative CTA may help to guide surgical technique and provide the surgeon with greater confidence intraoperatively, however, this study did not show significant change in operative outcomes. Further study and risk/benefit analysis may better highlight the role of CTA in pedicled TRAM flap planning.
ABSTRACT
BACKGROUND: The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site. METHOD: A cohort study of six patients (five male, one female; mean age 59 [range 19-90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra-flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap. RESULTS: In all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6-15 cm (mean 11.5 cm) and widths of 4-6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24-90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow-up of 6 months (4-24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15. CONCLUSION: The modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.