Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flap

The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of these patients had abdominal wall hernia and 26 (12.6%) had abdominal bulging. The incidence of hernia was significantly higher (P < 0.05) among patients with body mass index (BMI) ≥ 30 kg/m(2) (hernia incidence, 15.0%) than that among patients with BMI <30 kg/m(2) (hernia incidence, 3.2%), while the incidence of abdominal bulge was significantly lower (P < 0.05) among patients with BMI ≥ 30 kg/m(2) (abdominal bulge incidence, 5.0%) than that among patients with BMI ≥ 30 kg/m(2) (abdominal bulge incidence, 19.1%). Therefore, obesity was identified as a risk factor for abdominal wall hernia. It was also found that the use of mesh to reinforce the abdominal wall significantly reduced (P < 0.025) the incidence of hernia (use of mesh (hernia incidence, 2.5%) versus non-mesh (hernia incidence, 5.9%)) and abdominal bulge (use of mesh (abdominal bulge incidence, 9.9%) versus non-mesh (abdominal bulge incidence, 17.3%)) among the patients.