Abdominal Bulging and Hernia Following Pedicle Transverse Rectus Abdominis Muscle Musculocutaneous Flap Reconstruction in Breast Cancer Patient: Ramathibodi’s Hospital Experience
Youwanush Kongdan MD*, Prakasit Chirappapha MD*, Piyawan Kensakoo MD*, Rupporn Sukpanich MD*, Pornphan Wibulpolprasert MD**, Thongchai Sukarayothin MD*, Monchai Leesombatpaiboon MD*, Panuwat Lertsithichai MD*
Affiliation : * Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Transverse rectus abdominis myocutaneous flap (TRAM flap) following breast cancer surgery is a widely
accepted method for breast reconstruction or defect coverage. Donor site morbidity resulting from the procedure is a great
concern to surgeons and influences the patient’s quality of life. In the present study we report our incidence of abdominal
contour abnormalities after pedicled TRAM reconstruction and also the risk factors of these complications.
Objective : To identify incidence and risk factors of abdominal contour abnormalities after pedicled TRAM flap reconstruction.
Material and Method: We retrospectively reviewed the charts and operative notes of patients who underwent pedicled TRAM
reconstruction between January 2008 to December 2014. The abdominal deformities were recorded and the risk factors we
believed to be the cause of complication were identified and analyzed. The difference between the two techniques of TRAM flap
reconstruction being used at that time was also analyzed.
Results : 126 patients underwent pedicled TRAM flap reconstruction. We found that 23% of our patients had abdominal
complications which were higher than previous published literatures. The most common complication was abdominal
bulging (21%). However, we found that age was the risk factor associate with the abdominal contour deformities.
Conclusion : Although acceptable, the number of patients with abdominal wall bulging in the present study is still high
compared to previous studies. Only age (>40 years old) was a significant risk factor found in the present study. A further
refinement of the operating techniques are warranted to minimize the complications from this procedure.
Keywords : Transverse rectus abdominis myocutaneous flap (TRAM flap), Abdominal bulging
