Brief report: The use of dermal autograft for fascial repair of TRAM flap donor sites

Reconstruction of the breast and other tissues by the transverse rectus abdominis myocutaneous (TRAM) flap is an accepted, reliable technique with a high success rate. Closure of the anterior rectus sheath defect that results from this flap has been the subject of debate, since hernia formation is considered a risk. We have reviewed 20 patients from a consecutive series of free TRAM and pedicled TRAM flaps using dermal autograft removed from zone IV of the flap and 117 patients using mesh, and assessed the complication of these techniques. Average follow-up time was 21.7 months (ranged 5 months to 4 years). There was one wound infection (5%) and one bulging (5%) in the dermal autograft group and 2 (1.7) bulgings, 3 (0.85) hernias and 2 (1.7) infections in the mesh group. There was no significant difference in the complication rate between the two techniques though. We conclude that the principal advantages of the dermal autograft in TRAM flap donor site closure are ease of use, economy and the benefit of using an autologous, biological material.