[Closure of the abdominal wall after removal of a mucocutaneous flap from the transverse rectus abdominis for breast reconstruction. Apropos of 48 cases. Review of the literature]

Abstract

In view of the good results of breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap, we used this method in 48 patients, but we observed abdominal complications, which are difficult to accept for cosmetic surgery. Hartrampf, one of pioneers of this technique, reports a very low complication, rate by closing the abdominal wall without the use of prosthetic mesh. However his results are not reproducible as numerous authors, following his technique, have reported abdominal hernias and now use prosthetic reinforcement. In the light of our experience, we analyse these complications, not only hernias, but also abdominal weakness, indicating a new operation in some cases (6/9). The quality and duration of the follow-up (52 months) accounts for the fairly high complication rate. A review of literature examines the various means of abdominal wall closure and their results. The functional injury of muscular harvesting must also be considered, especially in sports women.