25.0: Thursday, March 17, 2005

The muscle sparing free TRAM . Review of 110 consecutive cases

Hisham Seify, MD and Frank L. Elliott.


The muscle sparing free TRAM is a reliable technique which provides great versatility with decreased donor site morbidity.The goal of this study is to identify the different technical aspects associated with this procedure as well as identifying peri-operative complications and outcomes .

Patients and methods:

Data was reviewed retrospectively and included patient demographics, operative time, and choice of recipient vessel, contralateral breast as well as outcome, patient satisfaction and peri-operative morbidities.


One hundred patients underwent free TRAM flap for breast reconstruction (88 immediate, 12 patients delayed).IMA was used in 74 cases, thoracodorsal in 36 cases. Average operative time was 185 minutes, average blood loss was 195 cc. Thirteen patients (13%) required mesh for abdominal wall closure. Sixteen patients (16%) had fat necrosis. Revision of the micro vascular anastomosis was done in 4 patients with flap salvage in all of them. Two patients had hematoma that required surgical evacuation, abdominal wall hernia was detected in two patients (2%) and required mesh repair.


The muscle sparing free TRAM flap established itself as a reliable technique for breast reconstruction. Advantages associated with the procedure include decreased donor site morbidity while preserving adequate blood supply to the flap.