Retrograde microvascular augmentation (turbocharging) of a single-pedicle TRAM flap through a deep inferior epigastric arterial and venous loop.

Abstract

Modern trends in breast reconstruction with the TRAM flap have promoted adequate blood supply to the flap while minimizing the donor-site defect in the anterior abdominal wall. Preservation of the rectus abdominis muscle (both unipedicled and bipedicled), supercharging, delayed, and free-flap techniques all have promoted these principles. A new technique is presented utilizing the single pedicle with a transmidline retrograde microvascular loop anastomosis of the deep inferior epigastric artery and vein. The turbocharging allows increased blood flow to the remote areas of the flap as well as augmented venous outflow. In addition, the abdominal-wall donor site is similar to that of a single pedicle. This technique is ideal for reconstruction where the entire flap is required, a lower abdominal scar is present, or the recipient vessels for the free flap are absent or damaged.