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Omranipour et al. Ipsilateral or contralateral TRAM flap

receptor, P53, Her2Neu), history of post-mastectomy regression analysis to evaluate their independence
radiotherapy or chemotherapy and finally the time as predictors. Odds ratio (OR) and 95% confidence
length between mastectomy and reconstruction intervals were calculated.
were abstracted from the medical records. Type of
pedicle TRAM (ipsilateral vs. contralateral), timing of RESULTS
the procedure (immediate vs. delayed), and usage
of mesh for the abdominal wall closure were also Table 1 presents the baseline characteristics of the
recorded. study population and the type of procedures. Out of
110 patients who were included in the study, 87 had
All patients had follow-up examinations every week for ipsilateral and 23 contralateral pedicle TRAM flaps.
the first month and monthly thereafter for 6 months. There were no significant differences in demographic
Postoperative outcomes were assessed using clinical characteristics between ipsilateral and contralateral
data records if available, otherwise we communicated pedicle TRAM flap groups. Tumor size and the
with the patients’ physicians. The mean follow-up number of lymph node involvement were higher in
duration was 2.69 years for ipsilateral group and 3.21 contralateral pedicle TRAM flap group. Immediate
years for contralateral group. reconstruction was more commonly performed in
contralateral pedicle TRAM flap group, (34.8% vs.
Immediate post-reconstructive complications were 10.3%, respectively).
recorded. Postoperative complications were then
categorized into major or minor events. Complications Co-morbidities included hypertension, diabetes mellitus,
which required re-admission or re-hospitalization such hyperlipidemia, presence of abdominal scar, and
as total flap loss were defined as complete necrosis smoking. The two procedures had similar clinical and
of the skin and fat; partial flap loss, was defined demographic characteristics. Co-morbidities were more
as ischemic tissue loss exceeding 25% of the flap. common in ipsilateral pedicle TRAM group.
Wound infection was defined as redness, swelling, and
exudate and requiring antibiotics. Seroma formation Table 2 summarizes the categories of complications
was defined as palpable fluctuation of subcutaneous during follow-up period. Comparing the ipsilateral with
tissues requiring suction or drainage. Hematoma, the contralateral TRAM groups, the incidence of flap
requiring evacuation, pulmonary embolism, sepsis, complications that did not require surgical intervention
hernia, ileus and acute renal failure were categorized was 19.7% in ipsilateral and 30.4% in contralateral
as major complications. All the other complications pedicle TRAM flap, respectively. The incidence of
were categorized as minor. flap loss requiring revision was significantly higher in
contralateral group (P = 0.001). Major complications
SPSS 20 (SPSS Inc., Chicago, IL, USA) was used (any complication that required hospital admission
for statistical analysis, with comparison of discrete or operative procedure) were noted in 11.5% of the
variables by Pearson chi-square or Fisher’s exact test, ipsilateral pedicle TRAM patients and 26.1% of the
and comparison of means by t-test. A value of P < contralateral group (P < 0.001). Minor complications
0.05 was considered significant. Predictors exhibiting were noted in 17.2% of the ipsilateral pedicle TRAM
a statistically significant relation with postoperative patients and in 34.8% of the contralateral group,
morbidity were taken for multivariate logistic respectively (P < 0.001). When individual complications

Table 1: Baseline characteristics of the study population and the type of procedures for breast reconstruction, n (%)
Ipsilateral pedicled Contralateral pedicled
Characteristics P
TRAM (n = 87) TRAM (n = 23)
Age (years), mean ± SD 42.58 ± 9.15 39.22 ± 6.6 0.99
2
Body mass index (kg/m ), mean ± SD 27.43 ± 4.28 24.54 ± 3.47 0.64
Diabetes mellitus 9 (10.1) 1 (4.3) 0.003
Hypertension 6 (6.9) 1 (4.3) 0.002
Hyperlipidemia 1 (1.1) 0 (0.0) 0.011
Tobacco use 7 (8) 1 (4.3) 0.005
Abdominal scar 22 (25.3) 11 (47.8) 0.004
History of radiotherapy 65 (74.7) 12 (52.2) 0.025
History of chemotherapy 61 (70.9) 19 (82.6) 0.67
Immediate reconstruction 9 (10.3) 8 (34.8) 0.001
Time between mastectomy and reconstruction 50.39 ± 42.14 36.51 ± 30.65 0.071
TRAM: transverse rectus abdominis myocutaneous
Plastic and Aesthetic Research ¦ Volume 4 ¦ September 29, 2017 157