A 25-year-old woman undergoes reconstruction after mastectomy using a TRAM flap (transverse rectus abdominis myocutaneous flap). Which of the following complications is specifically associated with the TRAM flap donor site?

• A Seroma of the breast reconstruction
• B Lymphoedema of the arm
• C Nipple-areola complex necrosis
• D Abdominal wall weakness or hernia due to rectus abdominis muscle sacrifice ✓

Explanation

The TRAM flap uses the rectus abdominis muscle with an overlying skin/fat paddle based on the deep inferior epigastric vessels (free TRAM) or the superior epigastric vessels (pedicled TRAM). The most significant donor-site morbidity is abdominal wall weakness or bulge/hernia resulting from sacrifice of the rectus abdominis muscle. To mitigate this, the DIEP (deep inferior epigastric perforator) flap was developed as a muscle-sparing alternative that harvests only the perforating vessels and overlying skin/fat without taking the muscle, significantly reducing donor-site 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.