Twitter YouTube LinkedIn

AAPS 2007 Annual Meeting, May 19 - 22, 2007, The Coeur d'Alene Resort, Coeur d'Alene, Idaho.
Back to Scientific Program
Back to Annual Meeting

DIEP Versus Free TRAM: A Meta-analysis of Complication Rates
Li-Xing Man, MD, MSC, Jesse C. Selber, MD, MPH, Joseph M. Serletti, MD, FACS.
University of Pennsylvania, Philadelphia, PA, USA.

Introduction: A multitude of studies compare the various microvascular free flap reconstructive techniques, with no consensus among them regarding differences in complications rates. Some studies suggest that the Deep Inferior Epigastric Artery flap has a less robust vascular supply than the Free Trans Rectus Abdominus Myocutaneous flap, while others show no difference in rates of fat necrosis and partial and total flap loss. Similarly, some studies show a higher rate of abdominal wall morbidity among Free TRAM patients when compared to DIEP patients, and other studies show no such difference. Many of the studies found in the literature are case series performed at single institutions and lack the power to demonstrate small differences in effect size. The object of this meta-analysis was to develop pooled comparisons of the risk of fat necrosis, partial and total flap loss, abdominal bulge, laxity, or weakness, and abdominal hernia after DIEP and free TRAM surgery in order to detect differences in complication profiles between these two operations, in the hope of elucidating small differences that may exist.
Methods: A MEDLINE and manual search of English-language articles on DIEP or free TRAM surgery published up to April 2006 yielded 289 citations. Two levels of screening with predefined criteria identified 30 relevant studies. Mantel-Haenszel fixed effects model and the DerSimonian and Laird random effects model were employed to perform the meta-analysis.
Results: Six studies reporting both DIEP and TRAM flap outcomes were used to estimate pooled relative risks (RR) of complications and confidence intervals (CIs). A muscle-sparing free TRAM technique was used in three of these studies. There was a 2-fold increase in risk for fat necrosis (RR 1.94; 95% CI 1.28, 2.93) and partial or total flap loss (RR 2.05; 95% CI 1.16, 3.61) in DIEP flap patients compared to those with TRAM flaps. However, there was no difference in the risk for fat necrosis when the analysis was limited to muscle-sparing free TRAM flaps (RR 0.91; 95% CI 0.47, 1.78). Patients receiving DIEP flaps had one-half the risk of developing abdominal bulge or hernia (RR 0.49; 95% CI 0.28, 0.86). This result was not altered when limiting the comparison to muscle-sparing free TRAM flaps. Twelve studies reporting DIEP flap outcomes and 19 studies reporting free TRAM flap outcomes were identified and used to estimate pooled complication rates using a random effects model to account for between-study heterogeneity. Pooled flap-related complication rates were similar for free DIEP and TRAM flaps, while donor-site morbidity was higher in the free TRAM flaps.
Conclusion: When pooled data is considered, small differences come to light. Our analysis suggests that the DIEP flap reduces abdominal morbidity, but appears to increase flap-related complications such as fat necrosis and flap loss compared to the free TRAM flap. These conclusions put to rest some long standing questions regarding complications and operative technique in free flap breast reconstruction.

Back to Scientific Program
Back to Annual Meeting
Quick Links
Annual Meeting
Twitter YouTube LinkedIn