Comparison of TRAM versus DIEP flap in total vaginal reconstruction after pelvic exenteration.

BACKGROUND: The purpose of this study was to compare the transverse rectus abdominis myocutaneous (TRAM) pedicled flap with a muscle and fascia-sparing flap based on the deep inferior epigastric perforator (DIEP) in total vaginal reconstruction. The authors studied the advantages and disadvantages of both flaps.

METHODS: From January of 1986 to July of 2010, 75 patients who underwent pelvic exenteration for gynecologic cancer were retrospectively reviewed. Sixty-two patients had recurrent disease and 13 had primary tumors. Forty patients underwent vaginal reconstruction, 21 with TRAM flaps and seven with DIEP flaps. Flap survival, donor-site morbidity, neovagina stenosis, flap harvest time, and hospital stay were registered for both groups.

RESULTS: All DIEP flaps survived in all patients. In the TRAM group, however, three flaps were lost because of total necrosis and five presented partial necrosis. Mean harvest time was 63 minutes for the DIEP flap and 105 minutes for the TRAM flap. No abdominal wall complications occurred in the DIEP flap group, whereas four cases of donor-site morbidity were registered in the TRAM group, even though mesh was used in all cases. During follow-up examination, all patients had normal-appearing external genitalia.

CONCLUSIONS: The DIEP flap seems to be a promising flap for this kind of reconstruction and could replace the TRAM flap. The authors detected a decrease in donor-site abdominal morbidity when using the DIEP flap compared with the TRAM flap.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.