INTRODUCTION:

The TRAM flap is the gold standard for autologous tissue breast reconstruction. Unfortunately, it is not always available. In some patients, a suitable amount of tissue can be harvested from the lateral thigh based on the tensor fascia lata (TFL) muscle. The purpose of this study is to review our experience using the TFL flap as an alternate source for autologous tissue breast reconstruction.

METHODS:

A retrospective chart review of all patients treated for breast reconstruction in our institution over a 10-year period was performed. Nineteen patients who underwent free TFL breast reconstruction were evaluated to determine the indication for choosing the TFL flap, operating time, transfusion requirements, hospital stay, incidence of major and minor complications, and number of secondary procedures performed.

RESULTS:

Nineteen patients with ages ranging from 36 - 64 (average=46) were identified. Fourteen patients had bilateral while 5 had unilateral TFL reconstruction for a total of 33 flaps. Twenty-one flaps (63%) were used for delayed reconstruction and 12 (37%) were immediate reconstructions. Twenty-four flaps (73%) were used to reconstruct prophylactic mastectomies or mechanical implant problems, 8 flaps (24%)were used to reconstruct mastectomies for cancer, with cancer stage ranging from 0 (DCIS) to IIIA, while 1 flap (3%) was used to reconstruct a chest wall defect resulting from radionecrosis of a previuosly TRAM flap-reconstructed mastectomy. Inadequate abdominal or gluteal tissue was the indication for 29 flaps (87%) while previous abdominal surgeries necessitated the rest. The operative time for unilateral reconstructions averaged 5.6 hours while bilateral reconstructions averaged 9.5 hours. The recipient vessels used were the thoracodorsal vessels in all cases (97%) except one, the chest wall reconstruction, where the thoracoacromial artery and external jugular vein were utilized. No unilateral cases required transfusion while 3 of the bilateral cases (21%) required 1 unit of blood and another case (7%) required 2 units. The length of hospital stay was 4.8 days for unilateral cases and 5.8 days for bilateral cases. Twenty-eight flaps out of the 33 are considered to have finished reconstruction while the remaining 5 are awaiting revisions. Of the 28 finished reconstructions 25 TFL flaps (89%) required 1 revision while 3 (11%) required 2 revisions. Twenty-three (82%) of the 28 donor sites required 1 revision, 3 (11%) required 2 or more, and 2 (7%) required no revision. The only major complication was 1 (3%)donor site wound dehiscence while 5 (15%) minor complications consisting of donor site seromas were recorded. No flap complications were found. The reconstruction achieved generally had more volume than anticipated, producing excellent breast projection. This includes the 1 case of chest wall reconstruction where the flap harvested was quite large, measuring 15cm x 35cm.

DICUSSION:

The TFL flap is an excellent alternative for breast reconstruction in patients who have sufficient tissues in the lateral thigh region. The operative time , transfusion requirements, hospital stay, complication rate, and number of secondary procedures required are not much different from those of TRAM flaps. Unlike the superior gluteal flap, flap elevation is straightforward, does not require patient repositioning, and pedicle length is adequate. Furthermore, simultaneous bilateral breast reconstruction is feasible. However, one must exercise caution during flap elevation to avoid excessive resection of tissues as this is associated with significant contour deformities that are often difficult to correct secondarily. Otherwise, complications are minimal.