The Surgically Delayed Unipedicled TRAM Flap for Breast Reconstruction

Surgical delay is one method of enhancing the vascularity of the lower abdominal transverse rectus abdominis musculocutaneous (TRAM) flap. The outcome of 7 patients who underwent surgical delay (by ligating both superficial and deep inferior epigastric vessels bilaterally) a week prior to definitive TRAM flap elevation is described. Three patients were smokers, 3 were obese, and 1 was an asthmatic on medication. A satisfactory aesthetic result was achieved in all patients and the complications that occurred were minor. Two patients developed minor skin necrosis due to inadequate trimming of zone 4 on the contralateral side to the pedicle and there were 3 cases of fat necrosis, which occurred below Scarpa's fascia. Surgical delay is a useful technique of breast reconstruction. It allows the flap to be centered safely in the lower abdomen. In the high-risk patient, delay may prevent the need for microsurgery or the sacrifice of both recti.