Ipsilateral Pedicled TRAM Flaps: The Safer Alternative?
Bibliographic record
Abstract
Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction has become a commonly performed procedure in the 1990s. The original description of the procedure was that of an ipsilaterally based pedicle procedure. Concerns about potential folding of the pedicle with possible compromise of the vascular supply led many surgeons to prefer the contralateral pedicle. Subsequently, there have been several large clinical series of pedicled TRAM flaps showing a relatively high complication rate related to flap vascularity problems. Partial flap necrosis rates in pedicled TRAM series range from 5 to 44 percent. These findings resulted in many centers favoring free TRAM flap breast reconstruction, despite an increase in resource use and negligible differences in complication rates. Ipsilateral pedicle TRAM flap breast reconstruction is not a commonly reported procedure and is reserved for cases for which scars preclude use of the contralateral pedicle. Simplicity and versatility of flap shaping, improved maintenance of the inframammary fold, and lack of disruption of the natural xiphoid hollow give ipsilateral TRAM flaps further advantages. This study reports on a series of 252 consecutive ipsilateral TRAM flap reconstructions in 190 patients. The majority of patients underwent muscle-sparing procedures with preservation of a medial and a lateral strip of rectus muscle. Immediate reconstruction was done in 104 of the 190 patients. Skin-sparing (69 patients) or skin-reduction procedures (21 patients) were used in 90 of the 104 patients (87 percent) undergoing immediate reconstruction. Complication rates were comparable to those of series reported for contralateral TRAM flaps, except that partial flap necrosis (2.0 percent) was less in this series. Risk factors were analyzed with regard to the most common complications seen in this study. Ipsilateral TRAM flap breast reconstruction is our preferred method, if available, because we believe that it has several advantages over the contralateral pedicled TRAM and this report suggests a lower partial flap necrosis rate than previously reported.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".