Change of Venous Pressure of Superficial Vascular System during Free TRAM Flap Elevation

ABSTRACT

PURPOSE: Free transverse rectus abdominis musculocutaneous(TRAM) flap is one of the most popular methods of breast reconstruction. But if fat necrosis and fatty induration occur at the reconstructed breast, they can make the breast harder and make it difficult to differentiate a tumor recurrence from them. To expect and prevent these complications, we measured the pressure change of the superficial venous system whose congestion can be the cause of them. METHODS: An intraoperative clinical study was done to compare venous pressure of superficial inferior epigastric vein(SIEV) before and after the elevation of free TRAM flap. Fourteen TRAM flaps were included and the pressures of SIEV were measured two times at the beginning of the elevation and just before the division of the inferior pedicle. RESULTS: The venous pressure in free TRAM flap was significantly higher after the flap elevation at both contralateral side and ipsilateral(p=0.005 and p=0.026 respectively). The four cases with vertical scar shower significantly greater increase at contralateral side than ipsilateral side(p=0.020). CONCLUSION: Intraoperative venous pressure recording can be an objective data for evaluating the congestion of TRAM flap and can help to prevent the complications of fat necrosis and fatty induration with venous superdrainage.