Microvascular augmentation of the blood supply of the contralateral side of the free transverse rectus abdominis musculocutaneous flap.

The free transverse rectus abdominis musculocutaneous (TRAM) flap is a recognized, reliable method of breast reconstruction after mastectomy. However, blood supply to the contralateral side of both the free and pedicled TRAM flap, especially in zone four, is often precarious. In patients with previous midline abdominal scars or with significant rectus divarication, both zones three and four are at risk of necrosis. Various techniques have been described to improve the reliability of the blood supply to the contralateral tissue in the pedicled TRAM flap, including prior delay and microvascular supplementation. We describe a new technique for augmentation of the blood supply of the contralateral side by microvascular anastomosis of the distal end of the ipsilateral deep inferior epigastric vessels to a contralateral periumbilical perforator of the opposite side. This technique produces reliable survival of contralateral tissue in zones three and four, even in the presence of midline scars, with minimal damage to the contralateral rectus muscle. The technique is also beneficial where large bulk of tissue is needed, such as in radical mastectomy patients, or when abdominal tissue is thin but the normal breast is large. Five patients in a series of 50 free TRAM flaps have been treated with the technique and the results are compared with other techniques.