The delayed TRAM flap.

As surgeons gain increased clinical experience with the transverse rectus abdominis myocutaneous (TRAM) flap, or autologous breast reconstruction, technical modifications aimed at improving flap reliability continue to evolve. These modifications have allowed the TRAM flap to be performed safely in a higher-risk patient population. The delayed TRAM flap appears to have an augmented arterial supply and a lesser degree of venous congestion following division of the deep inferior epigastric vessels 2 weeks prior to reconstruction. Ischemia-related complications have been reduced in high-risk patients with the use of the delayed TRAM.