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Omranipour et al. Ipsilateral or contralateral TRAM flap

seemed to be lower than the previously reported TRAM flap for breast reconstruction. We could not find
31.82% by Fathi et al. [11] The difference might be any correlation between previous radiotherapy and
explained by the differences in the definition of morbidities after contralateral or ipsilateral pedicle TRAM
postoperative morbidity and the time of follow-up flap. This result is similar to the study of Janiga et al. [9]
period in our study in comparison with theirs. We
did not encounter any total flap loss which is the The experience gained in these procedures during
most serious complication of microsurgical breast the last two decades has enabled surgeons to
reconstruction. identify certain risk factors such as obesity, previous
abdominal surgery, advanced age, and tobacco
Unlike some other previous reports we did not find use that can increase complication rates. Some
any correlation between age or BMI and morbidity in researchers suggest considering those factors as
this study. The only comorbidity which could increase contra-indications for a pedicle TRAM flap [15,16] . We
the rate of post-operative complications was smoking. did not find in our study a higher morbidity rates
associated with these risk factors except for smoking.
In this study we aimed to determine the superiority of The outcome of pedicle TRAM flap reconstruction in
ipsilateral or contralateral pedicle TRAM flap based obese patient was similar to non-obese patients in our
on postoperative complications and morbidity. There previous report [17] .
were differences in total morbidity, flap ischemia, flap
necrosis, sub-flap hematoma, sub-flap seroma, and flap The most important finding in this study is that it is not
infection, between the two pedicle TRAM flap groups. necessary to use contralateral TRAM flap to overcome
The rate of complications in contralateral pedicle TRAM the limitations of ipsilateral TRAM flap. Moreover, we
flaps (39.1%) was significantly higher than ipsilateral found out more complications in contralateral TRAM
pedicle TRAM flaps (19.5%), (P = 0.001). The type of flaps.
pedicle TRAM flap did affect the total postoperative
morbidity, even in the absence of other base line risk The present study had some limitations. It is a
factors and co-morbidities. Our results were contrary retrospective study, inevitably it could have confounding
to some previous reports which indicated that the type biases due to lack of information on some factors not
of pedicle TRAM flap does not increase postoperative available in the medical records. Patients in this study
complications. In Clugston et al. study of ipsilateral were operated on by different surgeons and this could
[8]
pedicle TRAMs, the authors reported a moderately affect the outcome of procedures. However, we were
high minor complication rate but a relatively low major successful in comparing the outcomes and morbidity-
complication rate [12] . free survival rates of the two commonly performed
pedicle TRAM flaps (ipsilateral vs. contralateral).
The rate of complications of pedicle TRAM flap in our
study (27.4%) is similar to other studies (16-41%) [13-16] . This study indicates that the overall outcome and
Partial flap necrosis in our study was 13.7% which is mid-term morbidity-free survivals of ipsilateral pedicle
less than previous reports by Janiga et al. (16-41%). TRAM flap breast reconstruction are statistically
[9]
superior to contralateral pedicle TRAM flap breast
We found that the rate of major complications reconstruction. Both of these procedures are
(needing re-hospitalization or re-operation) following reasonably feasible and safe. According to our findings
pedicle TRAM flap was 17.9%, while the rate of a we recommend against the use of contralateral pedicle
minor complication was 24.8%. Minor complications TRAM flap to overcome limitations of ipsilateral pedicle
included wound infection, seroma or hematoma TRAM flap. Larger prospective studies are required to
not requiring operation, and flap ischemia. Major address this conclusion. We believe that the ipsilateral
complications, were significantly higher in our compared to the contralateral pedicle TRAM flap has
contralateral group. This finding can be explained by noticeable advantages including total flap vascularity,
limitations of contralateral technique. Contralateral seroma formation, and partial flap necrosis. In the
pedicle TRAM flap seems to have some aesthetic end, a surgeon’s familiarity and experience with either
limitations due to ablation of the xiphoid subunits and procedure, is likely the most important predictor of a
the medial infra-mammary fold. There are also some good outcome.
limitations from the shorter pedicle length.
DECLARATIONS
In a previously irradiated breast, because of the ischemia
due to damage to the internal mammary vessels, Authors’ contributions
some surgeons prefer not to use ipsilateral pedicle Concept and design: R. Omranipour
Plastic and Aesthetic Research ¦ Volume 4 ¦ September 29, 2017 159