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AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
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Use of the TRAM vs Latissimus Dorsi Flap for Autologous Breast Reconstruction: A 10-Year Institutional Experience
Nicholas A. Tarola, MD, Nathan Dvor, Eugene Latyshev, James Fox, MD, Steven E. Copit, MD, John H. Moore, Jr., MD.
Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Purpose: A 10-year experience with TRAM and latissimus dorsi flap breast reconstruction in a university hospital was reviewed. One presumed benefit of the latissimus dorsi flap over the TRAM flap is the lower incidence of major complications and lower overall morbidity. The purpose of this study was to compare the incidence of major and minor complications between these two reconstructive options.
Methods: A 10-year retrospective office and hospital chart review was conducted between January 1995 and January 2005. All patients who underwent breast reconstruction during this time were included in the study. There were 460 TRAM flaps performed on 392 patients and 198 latissimus dorsi flaps performed on 155 patients.
Results: Over a 10-year period, 547 patients underwent breast reconstruction. Of the 392 patients who had TRAM flap procedures, there were 86 monopedicled, 11 monopedicled with mesh, 48 bipedicled, and 247 bipedicled with mesh. Of the 155 patients who had latissimus dorsi flap procedures, there were 43 bilateral flaps with tissue expanders (TE), 8 unilateral flaps without TE, and 104 unilateral flaps with TE. With hernia and flap loss considered as the major complications for TRAM flaps, the incidence of complete flap loss was 3/460 (0.65%) and partial flap loss was 14/460 (3%) and the incidence of herniation was 71/392 (18%) with a trend showing a difference between bipedicle flaps closed with and without mesh. Complete flap loss did not occur in any of the latissimus dorsi flap patients while the incidence of partial flap loss was 3/196 (1.5%). The donor seroma rate for latissimus flaps was 31%. The overall donor and flap site complications for TRAM flaps were 35 and 23%, respectively, and for latissimus dorsi flaps were 8.5 and 5.5%, respectively. The incidence of herniation following TRAM flap for nonsmokers (16%) was significantly lower than for smokers (35%) (p = 0.006). The average length of stay for TRAM flap patients was 4.4 days and for latissimus dorsi flap patient was 3.4 days.
Conclusion: As we have seen greater morbidity associated with the TRAM flap, in recent years our practice has been favoring the use of the latissimus dorsi flap. The latissimus flap carries with it a lower incidence of minor complications and both a lower potential for and incidence of major complications. In addition, patients have a shorter length of stay in the hospital following latissimus flap. We advocate the use of latissimus dorsi flap breast reconstruction when appropriate for our patients.

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