Breast Reconstruction With Muscle-Sparing Transverse Rectus Abdominis Musculocutaneous (TRAM) Flap

Objective: To explore the security , feasibility and surgical results of breast reconstruction with muscle-sparing transverse rectus abdominis musculocutaneous (TRAM) flap after mastectomy, which is the improvement for traditional transverse rectus abdominis musculocutaneous (TRAM) flap.Methods: 8 patients with muscle-sparing TRAM flap was carried out in 6 cases with immediate breast reconstruction and 2 cases with delayed breast reconstruction. No cases of inferior abdominal donor-site by using polyester patches to prevent abdominal weakness and hemia. The muscle-sparing TRAM flap and traditional TRAM flap have no difference in design proposal preop, breast reconstruction and shaping during the surgery, meanwhile, they have similar Surgical procedures. The muscle-sparing TRAM flap make improvement in the foundation of the traditional TRAM flap, what reserve lateral rectus abdominis in half size during the surgery emphatically. We should take computed tomography angiography (CTA) of superior epigastric artery, inferior epigastric artery before the surgery, what help us find out distribution of arterial branch and select operation scheme. With the follow-up, We shoule observe shape and symptom of the inferior abdominal donor-site, measure both sides of rectus abdominis in width and thickness with supersonic in 1 month,3 months latter. And determin muscle strength of the upper and lower rectus abdominis muscle in 3 months latter .Results:From September 2009 to September 2010, muscle-sparing TRAM flap performed on 8 patients, except for 1 case of breast reconstruction poor shape, the other case is good shape, the effect is satisfactory during the follow up of 3 months to 1 year. 2 cases with immediate breast reconstruction appeared fibrosis in some subcutaneous fat of flapâ…£area,2 cases with immediate breast reconstruction appeared borderline necrosis and subcutaneous fat liquefaction in minor area of flapâ…£area, Which healing after debridement latter. There were no abdominal weakness ,hemia and any other discomfort. Ultrasound examinations showed the width of the rectus abdominis retained more than half of the normal side, the thickness of the rectus abdominis retained more than 2 /3 of the normal side;Postoperative 1 month and 3 months phase comparison, the size of width and thickness is similar. Test of rectus abdominis muscle showed that the breast reconstruction with muscle-sparing transverse rectus abdominis musculocutaneous (TRAM) flap and traditional transverse rectus abdominis musculocutaneous (TRAM) flap comparison, muscle strength is similar, the difference was not significant, but lower than normal Human rectus muscles strength, However, patients'daily life and sport was not affected.Conclusion:The muscle-sparing TRAM flap is the innovation departure for the TRAM Flap. The outcome which muscle-sparing TRAM flap take into preliminary clinical Application show the reserve of rectus abdominis have no atrophy and normal function, decrease the complication of the abdominal donor site, processes of surgery are not time-consuming. I hope this operation will gave more affirmation and be recommended through a long term clinical practice and follow up obersavation.