Abdominal Wall Morbidity following Unilateral and Bilateral Breast Reconstruction with Pedicled TRAM Flaps: An Outcomes Analysis of 117 Consecutive Patients
Bibliographic record
Abstract
BACKGROUND: Recently, there has been increasing concern regarding the potential for abdominal wall morbidity following breast reconstruction with pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. The purpose of this study was to analyze a large, consecutive series of pedicled TRAM flaps performed by a single surgeon and examine the incidence of abdominal morbidity. METHODS: Between December of 1998 and June of 2005, 117 women underwent breast reconstruction with pedicled TRAM flaps by the senior author (J.A.A.). All abdominal repairs were reinforced with polypropylene mesh. Reconstruction was unilateral in 105 women (90 percent) and bilateral in 12 women (10 percent). The charts were reviewed retrospectively for abdominal complications and associated demographics. RESULTS: The mean follow-up period was 23.3 months. In the 117 patients, there was one hernia (0.85 percent), two abdominal wall bulges (1.7 percent), two superficial infections (1.7 percent), one partial skin loss (0.85 percent), one hematoma (0.85 percent), and zero seromas. Three patients (2.6 percent) had prolonged abdominal wall discomfort/tightness that was treated successfully with physical therapy. No patient developed a mesh infection or required mesh removal secondary to infection or exposure. In addition, no patient complained of persistent abdominal weakness, and there were no TRAM flap losses. CONCLUSIONS: Although many authors have reported concern over potentially high rates of abdominal wall morbidity following pedicled TRAM flaps, abdominal complication rates in the current series were uniformly low. The authors therefore believe that pedicled TRAM flaps remain a good option for many women seeking breast reconstruction.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".