Abdominal function after pedicled TRAM flap surgery.

Through the years, many surgeons have considered the potential for weakness in the abdominal wall as a major drawback to the use of the pedicled TRAM flap. This article begins with a review of the surgical anatomy of the abdominal wall. It continues with a review of technical details; beginning with a method of partial rectus muscle and fascia harvest that respects the vascular anatomy, and followed by multilayered direct fascial closure in all patients with selective alloplastic mesh reinforcement as necessary. It is the authors' opinion that these methods optimize postoperative abdominal function, leaving a competent abdominal wall that does not deteriorate through time. Supportive data gained through a 13-year experience with 662 patients are presented.