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DIEP and Pedicled TRAM Flaps: A Comparison of Outcomes

Garvey, Patrick B. M.D.; Buchel, Edward W. M.D.; Pockaj, Barbara A. M.D.; Casey, William J. III M.D.; Gray, Richard J. M.D.; Hernández, José L. B.A.; Samson, Thomas D. M.D.

Plastic and Reconstructive Surgery: May 2006 - Volume 117 - Issue 6 - p 1711-1719
doi: 10.1097/01.prs.0000210679.77449.7d
Breast: Original Articles

Background: Studies comparing similar and sizable numbers of deep inferior epigastric perforator (DIEP) and pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions are lacking. The authors hoped to determine whether the DIEP flap has advantages over the pedicled TRAM flap for breast reconstruction.

Methods: The authors retrospectively reviewed the records of women undergoing breast reconstruction over a 9-year period at a single institution. Patients were grouped by type of reconstruction: DIEP or pedicled TRAM. Only patients with at least 3 months of postoperative follow-up were studied.

Results: A total of 190 women underwent unilateral breast reconstructions (96 DIEP and 94 pedicled TRAM flaps). The patient groups were similar in terms of age, body mass index, preoperative chest wall irradiation and abdominal operations, and cancer stage. The median hospital stay for the DIEP group was shorter than that for the pedicled TRAM group (4 versus 5 days, p < .001). Operative time for the DIEP group (5:53 hours) was longer than that for the pedicled TRAM group (4:46 hours, p < .001). The fat necrosis rates for the pedicled TRAM group were higher (58.5 percent) than those for the DIEP group (17.7 percent, p < .001). Abdominal wall hernias occurred more frequently in pedicled TRAM (16.0 percent) than DIEP patients (1.0 percent, p < .001). Abdominal wall bulge rates were similar for both groups (DIEP 9.4 percent versus pedicled TRAM 14.9 percent).

Conclusions: DIEP flap reconstruction can be performed with lower morbidity rates and shorter hospital stays than pedicled TRAM reconstruction. Specifically, fat necrosis and abdominal wall hernias are less common in DIEP patients than in pedicled TRAM patients, while flap failure and abdominal wall bulging rates are similar in the two patient groups. These data support the DIEP flap as the preferred option over the pedicled TRAM flap for autologous breast reconstruction in postmastectomy patients.

Scottsdale, Ariz.; Winnipeg, Manitoba, Canada; and Chicago, Ill.

From the Division of General Surgery, Mayo Clinic; the Section of Plastic Surgery, University of Manitoba Health Sciences Center; and the University of Illinois at Chicago College of Medicine.

Received for publication May 12, 2004; revised October 3, 2005.

Edward W. Buchel, M.D., University of Manitoba, GC411 General Center, Winnipeg, Manitoba, Canada R3T 2N2,

©2006American Society of Plastic Surgeons