Prefabrication of a secondary TRAM flap.

A secondary TRAM flap was prefabricated in a rat model using the rectus muscle. The right rectus muscle was elevated as an inferiorly pedicled muscle flap in one experimental group (n = 6) and as a superiorly pedicled muscle flap in a second group (n = 5) and then sandwiched between a silicone sheet and the abdominal skin. Two weeks later, the abdominal skin and attached rectus muscle were elevated over the silicone sheet as a secondary TRAM flap. The surviving skin paddle areas of these prefabricated TRAM flaps were compared with superiorly (n = 7) and inferiorly (n = 8) pedicled TRAM flaps in a control group. One-way analysis of variance did not show significant differences between groups (p = 0.07). TRAM flap prefabrication in the rat model yields a skin paddle survival area comparable to that of a conventional TRAM flap, and it is possible to perform this procedure without using the anterior rectus sheath.