The purpose of this paper was to study the blood supply of the pedicle TRAM, free TRAM, and DIEP flaps in breast reconstruction.
A prospective study included 23 pedicle, 9 free TRAM, and 9 DIEP flaps. Each flap included zones I and III only and was used for breast reconstruction. Laser Doppler was used to obtain flow data for a peri-umbilical site on each flap. Flap complications were studied.
Average flow was highest at 4.86 for the free TRAM; DIEP (3.12) and pedicle TRAM (3.02) had similar average flow. Neither the free TRAM flap group nor DIEP flap developed clinical fat necrosis, while the pedicle TRAM group had 2 patients with transient venous congestion and subsequent clinically palpable fat necrosis.
DIEP and pedicle TRAM flaps have similar vascularity, but pedicle TRAMs demonstrate fat necrosis likely due to venous congestion. The free TRAM has a better blood supply than the DIEP and pedicle TRAM flaps.
