A patient undergoes reconstruction after mastectomy using a TRAM (Transverse Rectus Abdominis Myocutaneous) flap. Which of the following is the PRIMARY blood supply to a pedicled TRAM flap?
- A Deep inferior epigastric artery (DIEA)
- B Superficial inferior epigastric artery (SIEA)
- C Superior epigastric artery — the continuation of the internal mammary artery ✓
- D Circumflex iliac artery
Correct answer: C. Superior epigastric artery — the continuation of the internal mammary artery
Explanation
In a pedicled TRAM flap, the rectus abdominis muscle is raised on the superior epigastric vessels (continuation of the internal mammary/thoracic artery), and the skin island is carried on this pedicle tunnelled subcutaneously to the chest. In contrast, a free TRAM or DIEP (Deep Inferior Epigastric Perforator) flap uses the deep inferior epigastric artery as the primary supply and requires microsurgical anastomosis. DIEP flaps spare the rectus muscle, reducing abdominal morbidity.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.