Free Transverse Rectus Abdominis Myocutaneous

(TRAM) Flap Reconstruction
Description
The operation is performed under general anesthesia, sometimes supplemented by a
paravertebral or epidural block. Adequate preoperative planning and preparation is key
to the success of TRAM fl ap breast reconstruction. Good lighting, careful positioning,
and high-quality equipment simplify the procedure. Appropriate intravenous antibiotics
are given for 24 h or more. An island of skin and underlying rectus abdominis muscle is
raised from the lower abdomen attached to its inferior vascular pedicle (inferior epigastric
vessels) and divided. Immediate free-TRAM fl ap breast reconstruction (ITRAM)
is carried out at the same time as mastectomy (Figs. 2.6 , 2.7 and 2.8 ).