What is the anatomy of the rectus abdominis muscle relevant to a unipedicled TRAM breast reconstruction?

Updated: Feb 14, 2019
  • Author: Michael R Zenn, MD, MBA, FACS; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

The flap skin and fat of a single pedicle transverse rectus abdominis myocutaneous (TRAM) flap reconstruction survive on perforators through the rectus abdominis muscle. Although this muscle has a dual blood supply, the superior epigastric artery and the inferior epigastric artery, this operation relies only on the superior epigastric arterial system. Because of the distant nature of this blood supply, only tissues directly over or immediately adjacent to the muscle have adequate vascularity. If more tissues are needed, consider other procedures (midabdominal TRAM, delay procedure, double pedicle TRAM, super-charged TRAM, free TRAM flap, deep inferior epigastric perforator [DIEP] flap).


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