Back from the Future: Reappraisal of the Pedicled TRAM Flap in “Standard” Patients

Since Hartrampf’ s original description of the pedicled transverse rectus abdominis myocutaneous (TRAM) flap [1, 2], this procedure has undergone a gradual evolution: the development of microsurgical techniques, involving the sacrifice of only a small segment of rectus muscle or even preserving it [3]–[8], could overcome many of the drawbacks of the standard operation (donor site morbidity, fat necrosis caused by poor blood supply, etc.) [9]–[11]. However, according to the literature, no general consensus exists with respect to one technique or the other, either in terms of outcomes, complication rates or costs [12]–[19].