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Omranipour et al. Ipsilateral or contralateral TRAM flap

pedicle TRAM patients and in 34.8% of the contralateral group (P < 0.001). Total early hospital stay was longer in contralateral
pedicle TRAM flaps (7.66 days vs. 10.68 days, P = 0.83). Higher complications were encountered in contralateral pedicle TRAM
flaps compared to ipsilateral pedicle TRAM patients (39.1% vs. 19.5%, P = 0.001). The type of pedicled TRAM flap (ipsilateral vs.
contralateral), had significant effect on complications (odds ratio = 0.007, P = 0.002) while other variables had no significant effect on
the incidence of complications. Conclusion: This study indicates that the overall outcome and mid-term morbidity-free survivals of
ipsilateral pedicle TRAM flap breast reconstruction are statistically superior to contralateral pedicle TRAM flap breast reconstruction.
Both of these procedures are reasonably feasible and safe. These findings lead us to discourage the use of contralateral pedicle TRAM
flap when an ipsilateral option is feasible.

INTRODUCTION reduce the blood supply of the flap [7,8] . In order to
avoid the folding and the vascular flow surgeons have
Breast reconstruction has several beneficial effects on preferred to use the contralateral pedicle TRAM flap.
the psychosocial well-being and quality of life. Different The contralateral pedicle TRAM flap also seemed
studies have shown that breast reconstruction to have some aesthetic limitations due to ablation of
improves self-image, sexuality, and decreased rates the xiphoid subunits and the medial infra-mammary
[1]
of depression in women who have had mastectomy . fold. There are also some limitations from the
Additionally, patients who undergone reconstruction shorter pedicle length . There are reports indicating
[7]
with autologous tissue, in comparison with those who differences in early and long-term outcome of these
have undergone reconstruction with tissue expanders/ two techniques . Some authors reported similar
[9]
implants, have better long-term quality of life . safety of both techniques [10] while others favored one
[2]
pedicle TRAM technique over the other one [8,9] .
Transverse rectus abdominis myocutaneous (TRAM)
techniques have long been applied but selecting a Our objective was to retrospectively compare
superior technique is controversial. The selection of outcomes of ipsilateral and contralateral pedicle TRAM
the best procedure significantly affects the outcome flaps in a retrospective cohort study. In our center
of flap viability, patients’ satisfaction, and quality of free flaps for breast reconstruction are not routinely
life . The pedicle TRAM flap is still one of the most performed. Therefore we performed this study to
[3]
common procedure performed in many centers. analyze the outcomes and complications of TRAM
Our study demonstrates that it is associated with flaps performed in our center. We were able to assess
a low complication rate and a high level of patient the risk factors which could cause more post-operative
[4]
satisfaction in our center . complications and compare the results of ipsilateral
and contralateral TRAM flaps retrospectively. We
Morbidity and adverse events following different are aware that free flaps will substitute TRAM flaps
reconstructive breast surgeries are reported to be inevitably, so in this study we measured the results of
widely varied. In general, patients selected for pedicle TRAM flaps in our center. The study primary endpoints
TRAM flap reconstruction must have adequate were postoperative morbidity (defined as occurrence
abdominal soft tissue for the procedure to be of at least one of the postoperative complications
successful. There are several identified risk factors within the follow-up period), need for re-hospitalization
contributing to the post operative complications of and need for re-operation.
pedicle TRAM flap reconstruction. These factors
are cigarette smoking, obesity, prior radiation METHODS
therapy, abdominal surgery, and significant medical
[5]
comorbidities . In total of 110 patients who underwent unilateral breast
reconstruction with pedicle TRAM flap at the Cancer
As the experience and comfort with micro-surgical Institute of Tehran University of Medical sciences
techniques and instrumentation and post-op from January 1996 to June 2011, were included in
monitoring facilities are not available in all centers. this study. The ethics committee accepted this study
Surgeons perform the pedicle TRAM flap because it and the patients were informed about it during their
demands less technical and facility requirements and follow-up exams. Patients with micro-vascular super-
has fewer complete flap loss in comparison with free charging of the flap or those who received a bi-pedicle
[6]
flap techniques . or bilateral TRAM flap were excluded. Patients’ age,
height, weight, history of smoking, and associated
Rotation of pedicle TRAM flap can be ipsilateral comorbidities (diabetes mellitus, dyslipidemia and
or contralateral. Some surgeons believe that the hypertension), steroid use, history of liposuction, tumor
ipsilateral procedure might result in more tension on staging (based on TNM criteria), presence of tumor
the vascular pedicle and folding of the pedicle could markers (estrogen receptor status, progesterone
156 Plastic and Aesthetic Research ¦ Volume 4 ¦ September 29, 2017