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Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes

The introduction of microsurgery has decreased the frequency of using the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, owing to its higher incidence of fat necrosis and limitations in flap insetting (vs. the free TRAM flap). We devised an efficient method of using zones 2 and 4...

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Autores principales: Yoon, Chi Sun, Kim, Kyu Nam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723369/
https://www.ncbi.nlm.nih.gov/pubmed/26839761
http://dx.doi.org/10.1186/s40064-016-1714-7
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author Yoon, Chi Sun
Kim, Kyu Nam
author_facet Yoon, Chi Sun
Kim, Kyu Nam
author_sort Yoon, Chi Sun
collection PubMed
description The introduction of microsurgery has decreased the frequency of using the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, owing to its higher incidence of fat necrosis and limitations in flap insetting (vs. the free TRAM flap). We devised an efficient method of using zones 2 and 4, based on the pedicled flap’s vascular anatomy, to reduce fat necrosis and achieve superior aesthetic outcomes during immediate breast reconstruction using the pedicled TRAM flap. Between April 2011 and February 2015, we performed immediate breast reconstruction using the contralateral unipedicled TRAM flap for 136 breast cancer patients. The conventional method (insetting by removing zone 4 and part of zone 2) was used for 83 patients (Group A), and selective salvage of zones 2 and 4 (our proposed method) was used for 53 patients (Group B). Fat necrosis was observed in 17 patients (20.48 %) and 4 patients (7.55 %) from Groups A and B, respectively (p = 0.033). The average patient satisfaction scores at 6 months (comparing the reconstructed and contralateral breasts) were 7.01 and 8.02 in Groups A and B, respectively (p < 0.001). Liposuction to improve the upper-pole contour was performed at 6 months for 13 patients in Group A, although no patients in Group B required a secondary procedure (p = 0.002). Fat necrosis can be reduced via selective salvage of zones 2 and 4, based on the pedicled TRAM flap’s vascular anatomy. Furthermore, superior aesthetic outcomes can be achieved via flap insetting using the three-dimensional concept. Level of evidence Procedure comparison, Level II.
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spelling pubmed-47233692016-02-02 Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes Yoon, Chi Sun Kim, Kyu Nam Springerplus Research The introduction of microsurgery has decreased the frequency of using the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, owing to its higher incidence of fat necrosis and limitations in flap insetting (vs. the free TRAM flap). We devised an efficient method of using zones 2 and 4, based on the pedicled flap’s vascular anatomy, to reduce fat necrosis and achieve superior aesthetic outcomes during immediate breast reconstruction using the pedicled TRAM flap. Between April 2011 and February 2015, we performed immediate breast reconstruction using the contralateral unipedicled TRAM flap for 136 breast cancer patients. The conventional method (insetting by removing zone 4 and part of zone 2) was used for 83 patients (Group A), and selective salvage of zones 2 and 4 (our proposed method) was used for 53 patients (Group B). Fat necrosis was observed in 17 patients (20.48 %) and 4 patients (7.55 %) from Groups A and B, respectively (p = 0.033). The average patient satisfaction scores at 6 months (comparing the reconstructed and contralateral breasts) were 7.01 and 8.02 in Groups A and B, respectively (p < 0.001). Liposuction to improve the upper-pole contour was performed at 6 months for 13 patients in Group A, although no patients in Group B required a secondary procedure (p = 0.002). Fat necrosis can be reduced via selective salvage of zones 2 and 4, based on the pedicled TRAM flap’s vascular anatomy. Furthermore, superior aesthetic outcomes can be achieved via flap insetting using the three-dimensional concept. Level of evidence Procedure comparison, Level II. Springer International Publishing 2016-01-22 /pmc/articles/PMC4723369/ /pubmed/26839761 http://dx.doi.org/10.1186/s40064-016-1714-7 Text en © Yoon and Kim. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Yoon, Chi Sun
Kim, Kyu Nam
Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes
title Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes
title_full Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes
title_fullStr Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes
title_full_unstemmed Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes
title_short Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes
title_sort selective salvage of zones 2 and 4 in the pedicled tram flap: a focus on reducing fat necrosis and improving aesthetic outcomes
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723369/
https://www.ncbi.nlm.nih.gov/pubmed/26839761
http://dx.doi.org/10.1186/s40064-016-1714-7
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