Research Article| Volume 40, ISSUE 4, P367-370, July 1987

Augmentation of circulation of pedicled transverse rectus abdominis musculocutaneous flaps by microvascular surgery

      This paper is only available as a PDF. To read, Please Download here.


      The biggest problem of the TRAM flap for breast reconstruction is distal necrosis or fat lysis due to poor circulation. In order to utilise the entire TRAM flap tissue in extensive tissue defects, the contralateral rectus muscle is used as a pedicled carrier and the ipsilateral superficial or inferior epigastric vessels are anastomosed with appropriate recipient vessels in the axilla. This procedure has been performed in three cases with no necrosis, fat lysis or hardening of the flap tissue, proving adequate circulation in the flap.


        • Elliot L.F.
        • Hartrampf Jr, C.R.
        Tailoring of the new breast using the transverse abdominal island flap.
        Plastic and Reconstructive Surgery. 1983; 72: 887
        • Friedman R.J.
        • Argenta L.C.
        • Anderson R.
        Deep inferior epigastric free flap for breast reconstruction after radical mastectomy.
        Plastic and Reconstructive Surgery. 1985; 76: 455
        • Harii K.
        • Iwaya T.
        • Kawaguchi N.
        Combination myocutaneous flap and microvascular free flap.
        Plastic and Reconstructive Surgery. 1981; 68: 710
        • Hartrampf C.R.
        • Scheflan M.
        • Black P.W.
        Breast reconstruction with a transverse abdominal island flap.
        Plastic and Reconstructive Surgery. 1982; 69: 216
        • Hester Jr, T.R.
        • Nahai F.
        • Beegle P.E.
        • Bostwick III, J.
        Blood supply of the abdomen revisited, with emphasis on the superficial inferior epigastric artery.
        Plastic and Reconstructive Surgery. 1984; 74: 657
        • Ishii Jr, C.H.
        • Bostwick III, J.
        • Raine T.J.
        • Coleman III, J.J.
        • Hester Jr, T.R.
        Double-pedicled transverse rectus abdominis myocutaneous flap for unilateral breast and chest wall reconstruction.
        Plastic and Reconstructive Surgery. 1985; 76: 901
        • Taylor G.I.
        • Corlett R.J.
        • Boyd B.
        The versatile deep inferior epigastric (inferior rectus abdominis) flap.
        British Journal of Plastic Surgery. 1984; 37: 330