Complications and Patient-reported Outcomes after TRAM and DIEP Flaps: A Systematic Review and Meta-analysis

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dc.contributor.authorHe, Waverley Y.
dc.contributor.authorEter, Leen El
dc.contributor.authorYesantharao, Pooja
dc.contributor.authorHung, Bethany
dc.contributor.authorOwens, Haley
dc.contributor.authorPersing, Sarah
dc.contributor.authorSacks, Justin M.
dc.date.accessioned2020-11-25T17:05:43Z
dc.date.available2020-11-25T17:05:43Z
dc.date.issued2020-07-27
dc.description.abstractIntroduction: Transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric artery perforator (DIEP) flaps are the most common abdominally based breast reconstruction procedures. Each technique has its advantages and disadvantages; however, how morbidity relates to satisfaction is not well-understood. Our aim was to compare complications and patient-reported outcomes following pedicled TRAM (pTRAM), free TRAM (fTRAM), and DIEP flaps to guide flap selection. Methods: A systematic literature search was conducted, and 2 independent reviewers identified comparative studies of abdominally based flaps. Data were extracted on patient characteristics, complications, and patient-reported outcomes. Meta-analyses were conducted using random effects modeling with the DerSimonian and Laird method. Results: The search retrieved 5090 articles, of which 18 were included in this review. pTRAM flaps trended toward a higher risk of abdominal bulge/hernia compared with DIEP flaps, particularly in low-volume hospitals. While fTRAM flaps had a higher risk of abdominal morbidity compared with DIEP flaps, relative risk decreased when obese patients were excluded and when only muscle-sparing fTRAM flaps were compared. Muscle-sparing flaps had a higher risk of flap loss than fTRAM flaps. Compared with DIEP flaps, pTRAM flaps were associated with lower general satisfaction but comparable emotional well-being. Conclusions: Our findings indicate that safety and satisfaction following abdominally based breast reconstruction depend on flap type and patient characteristics. When possible, DIEP or muscle-sparing fTRAM flaps should be performed for obese patients to decrease the risk of abdominal bulge/hernia. Although pTRAM flaps are associated with a greater risk of flap loss, they are still an appropriate option when microsurgery is not available.en_US
dc.description.sponsorshipWe thank Stella Seal, MLS, for her assistance in developing and conducting a search strategy.en_US
dc.description.urihttps://journals.lww.com/prsgo/Fulltext/2020/10000/Complications_and_Patient_reported_Outcomes_after.8.aspxen_US
dc.format.extent10 pagesen_US
dc.genrejournal articlesen_US
dc.identifierdoi:10.13016/m2qrsh-faf4
dc.identifier.citationHe, Waverley Y. BA; El Eter, Leen BS; Yesantharao, Pooja MS; Hung, Bethany BS; Owens, Haley; Persing, Sarah MD, MPH; Sacks, Justin M. MD, MBA, Complications and Patient-reported Outcomes after TRAM and DIEP Flaps: A Systematic Review and Meta-analysis, Plastic and Reconstructive Surgery - Global Open: October 2020 - Volume 8 - Issue 10 - p e3120 doi: 10.1097/GOX.0000000000003120en_US
dc.identifier.urihttps://doi.org/10.1097/GOX.0000000000003120
dc.identifier.urihttp://hdl.handle.net/11603/20139
dc.language.isoen_USen_US
dc.publisherWolters Kluwer Healthen_US
dc.relation.isAvailableAtThe University of Maryland, Baltimore County (UMBC)
dc.relation.ispartofUMBC Biological Sciences Department Collection
dc.relation.ispartofUMBC Student Collection
dc.rightsThis item is likely protected under Title 17 of the U.S. Copyright Law. Unless on a Creative Commons license, for uses protected by Copyright Law, contact the copyright holder or the author.
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.titleComplications and Patient-reported Outcomes after TRAM and DIEP Flaps: A Systematic Review and Meta-analysisen_US
dc.typeTexten_US

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