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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.
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© 1987 The Trustees of British Association of Plastic Surgeons. All rights reserved. Published by Elsevier Inc.