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Comparison of Fat Necrosis Between Zone II and Zone III in Pedicled Transverse Rectus Abdominis Musculocutaneous Flaps: A Prospective Study of 400 Consecutive Cases

Kim, Eun Key MD; Lee, Taik Jong MD, PhD; Eom, Jin Sup MD

doi: 10.1097/
Original Article

Fat necrosis in transverse rectus abdominis musculocutaneous (TRAM) flap is considered to be mainly affected by blood supply. This prospective study compares the incidence of fat necrosis between zones II and III in 400 consecutive patients who had undergone unipedicled TRAM flap breast reconstruction. Fifty-eight patients (14.5%) suffered from fat necrosis, and 7 had 2 separate nodules. Fifty-four occurred in zone II, 10 in zone III, and 1 in zone I. The incidence of fat necrosis in zone II was significantly higher than in zone III (P < 0.001). The weight of the mastectomy specimen and the relative amount of zone II tissue included in the flap had positive correlation with the incidence of fat necrosis. This result implies relatively poor perfusion of zone II compared with zone III.

In a series of 400 consecutive unipedicled TRAM flap breast reconstructions, fat necrosis was noted in 54 patients in zone II (across the midline) but only 10 in zone III.

From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Reprints: Taik Jong Lee, MD, PhD, Department of Plastic Surgery, Asan Medical Center, Songpa-gu, Poongnap2-dong, 388-1, Seoul, 138-736, Korea. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.