Primary closure of anterior rectus fascia after monopedicled tram harvest for breast reconstruction

ABSTRACT

Dissection of pedicled TRAM flap results in defects of both rectus muscle and anterior rectus fascia, which may cause considerable donor-site morbidity. The aim of this work is to introduce a technical modification to preserve partly anterior rectus fascia to allow its primary closure and avoid abdominal wall complications mainly hernia and abdominal bulge. Twenty two consecutive patients who underwent breast reconstruction with monopedicled TRAM flap were evaluated after primary closure of rectus fascia without mesh, regarding postoperative abdominal wall complications. Mean age of patients was 43.8y [30y-52y]. Eighteen patients underwent immediate breast reconstruction, while 4 patients underwent delayed breast reconstruction. Donor site complications was 18% and included infection, seroma and partial necrosis of the umbilicus. There was no hernia, only one patient developed abdominal bulge. Flap related complications included partial flap loss in 3 patients. There was no delay in starting adjuvant treatment in the immediate reconstruction group. It is a safe technique, which enables surgeons to dissect the flap and preserve larger area of rectus fascia to allow its primary closure without donor-site complications. We believe that this modification prevents hernia and abdominal bulge, but we need larger number of patients to better evaluate this technique