A TRAM Flap Harvesting Technique for Breast Reconstruction Surgery after Mastectomy

Introduction. Currently, the best option for breast reconstruction surgery after mastectomy is TRAM-flap harvesting on a vascular pedicle from the inferior epigastric artery with taking one or two rectus abdominis muscles. However, it is widely reported about cases of marginal necrosis of the lower TRAM flap in the recipient zone. This is due to the area of obstructed blood flow "choke" at the site of anastomosis of the terminal muscular branches of the superior and inferior epigastric arteries.
The aim of the study was to investigate the applied topographical features of the lower epigastric arteries in the thickness of the rectus abdominis muscles in women.
Materials and methods. The main trunk of the inferior epigastric artery and its terminal branches (III and IV blood supply zones) were dissected on the muscular-aponeurotic flap of the anterior abdominal wall in the thickness of the rectus abdominis muscle in 18 non-fixed female corpses to identify the lower site of arterial anastomosis of the muscular branches. The authors measured the distance from the white line of the abdomen to the point of entry of the studied artery into the thickness of the rectus abdominis muscle, the length of the main trunk, and the vertical distance from the conditional horizontal line drawn through the upper semicircle of the umbilical ring to the beginning of the inferior epigastric artery branching (the "choke" zone).
Research results. The length of the major trunk of the inferior epigastric artery from the level of perforation of the posterior wall of the aponeurotic sheath of the rectus abdominis muscle to the beginning of its division averaged 5.7±0.8 cm. The level of division of the major trunk into muscular branches of the inferior epigastric artery on the left and right, and, consequently, the “choke” zone, was always higher than the level of the umbilical ring. The distance from the conditional horizontal line drawn through the upper semicircle of the umbilical ring to the beginning of the branching of the major trunk averaged 1.4±0.9 cm.
Conclusion. The data obtained on the typical anatomy of the inferior epigastric arteries in women may allow improving the TRAM flap harvesting on the musculovascular pedicle technique in order to reduce the risk of developing marginal skin necrosis in the recipient zone.