Autologous breast reconstruction, using pedicled TRAM flap - an outcome study
West Indian med. j
; West Indian med. j;47(Suppl. 3): 37, July 1998.
Article
em En
| MedCarib
| ID: med-1698
Biblioteca responsável:
JM3.1
Localização: JM3.1; R18.W4
ABSTRACT
Since its introduction by Hartrampf et al, the TRAM flap has proven to be a superior method of breast reconstruction in comparison to other techniques. This versatile flap provides a large quantity of autologous tissue, a lasting realistic breast mound in terms of ptosis, texture and symmetry. A retrospective study of cases of breast reconstruction using the pedicled TRAM flap was performed to identify outcomes and to justify or abandon the use of this procedure as a consistent reconstructive modality in breast construction. We reviewed 20 consecutive cases between July 1993 and December 1997 which were performed at two New York City Teaching Hospitals by one surgeon with residents assisting. There were 18 single pedicle flaps, 3 double pedicle and one bilateral TRAM flap. Fifteen flaps were delayed reconstructions while 5 patients had immediate reconstruction. The age range was form 28 to 63 years, the average being 43.7 years. The average follow up was 24.28 months. In all patients a modified radical mastectomy was performed by an oncologic surgeon, whose primary aim was complete tumor extirpation. In 3 patients there was a need for adjuvant chemotherapy, and this was usually administered 3 weeks after the mastectomy and reconstruction. In no instance was adjuvant chemotherapy delayed because of the reconstruction procedure. The average operating time was 4.5 hours for a single-pedicle TRAM and 6 hours for a bipedicle TRAM. There were complications in eight cases 2 seromas; 3 with partial flap loss (2 were allowed to heal by secondary intention and one will require a latissimus dorsi flap for revision); 2 hernias treated with prosthetic mesh; and one umbilical loss. There was no perioperative mortality and the average hospitalization was 5 days for a single pedicle and 6.5 for bipedicle TRAM. There have been 2 deaths subsequently one patient with cerebral metastases, one year after the procedure, and another with complications of lung cancer 3 months after surgery and adjuvant chemotherapy. We concluded that the pedicle TRAM flap is a reliable method of breast reconstruction with a predictable and satisfactory outcome and with minor complications it strict patient selection is observed. The resultant breast mound is uniformly accepted by the reconstructive surgeon and, most importantly, the patient, who has lost a significant part to cancer.(AU)
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Coleções:
01-internacional
Base de dados:
MedCarib
Assunto principal:
Retalhos Cirúrgicos
/
Mamoplastia
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
Idioma:
En
Revista:
West Indian med. j
Ano de publicação:
1998
Tipo de documento:
Article