Three-layer primary closure of the bipedicled TRAM flap donor site for unilateral breast reconstruction: a 15-year experience with 124 consecutive patients

Authors: HÜSEYİN KARAGÖZ, CİHAN ŞAHİN, CELALETTİN SEVER, YALÇIN KÜLAHCI, FİKRET EREN, CEYHUN CESUR, FUAT YÜKSEL

Abstract: Background/aim: The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains widely used as a breast reconstruction technique. The bipedicled TRAM flap is not as preferable as it was formerly, mainly because of its donor site complications. However, in a number of situations, a bipedicled TRAM flap may be the only alternative. Therefore, a three-layer primary closure technique used with bipedicled TRAM flap breast reconstructions that can avoid donor site complications without using a mesh is presented. Materials and methods: A retrospective study was performed that included patients who underwent bipedicled TRAM flap breast reconstruction with the three-layer primary closure technique. Between 2000 and 2015, 124 breast reconstruction patients were reviewed for donor site morbidity. Results: During the 15-year study period, 106 patients had conventional bipedicled TRAM flaps and 18 had bipedicled TRAM flaps with a surgical delay procedure. For all groups, none of the patients developed abdominal wall hernia, but three patients had bulging. Partial flap loss was the most common flap complication, present in 6 flaps (4.8%). Conclusion: The suturing technique studied provided abdominal wall closure without the use of a mesh even when utilizing a bilateral pedicle with very low complication rates.

Keywords: Abdominal hernia, donor site complication, pedicled transverse rectus abdominis myocutaneous flap, primary closure, TRAM flap

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