RESUMEN
The transverse rectus abdominis myocutaneous flap [TRAM] is a popular method of autologous breast reconstruction that results in a soft, natural looking ptotic breast and does not need addition prosthetic volume replacement giving an excellent cosmetic result, however, ischaemic related complications including partial-or total flap loss and fat necrosis continue to occur. In this report we describe our experience in TRAM flap breast reconstruction using vascular delay in high-risk patients in an effort to decrease ischaemic related flap complications. Nineteen patients underwent unilateral breast reconstruction using a unipedicled vascular delay TRAM flap between March, 1997 and May, 2000. All patients had one or more risk factors including obesity, previous irradiation, chronic cigarette smoking,diabetes or abdominal scars. Eleven cases had mastectomy with vascular delay then reconstruction while 8 had reconstruction done- after completion of their.adjuvant therapy There. Were nmo cases with total flap loss. We had one case with partial flap loss needing debridment and secondary sutures and one with a patch of epidermal sloughing which responded to conservative measures. Minimal fat necrosis was seen in one case. There was no mortality in our cases and the cosmetic results and patient satisfaction ranged from satisfactory to excellent. We believe that vascular delay and unipedicled TRAM flap reconstruction of the breast in high-risk patients is a simple, reliable procedure with a predictable outcome and satisfactory results. Its only drawback is the need for 2 surgical procedures which is a small price to pay especially in high-risk patients who have a very high flap complication rate using other methods of reconstruction