Current Role of Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction: Review and Case Reports.

[BACKGROUND] The pedicled transverse rectus abdominis myocutaneous (pTRAM) flap has long been a cornerstone in breast reconstruction. Despite the increasing adoption of muscle-sparing options such as the deep inferior epigasetric perforator flap, the pTRAM remains relevant, particularly in resource-limited settings or in patients unsuitable for microsurgery. This systematic review aimed to evaluate its current indications, outcomes, and clinical utility.

[METHODS] Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search of PubMed was conducted using the terms "pedicled TRAM flap" and "breast reconstruction," covering studies published from 2014 to 2024. A total of 43 articles, including original studies and case reports, met the inclusion criteria. Additionally, 2 clinical cases from our institution were presented to illustrate contemporary applications.

[RESULTS] The pTRAM flap offers several advantages: shorter operative times, independence from microvascular techniques, and versatility in complex reconstructive scenarios. It is especially suitable for patients with prior radiation therapy, vessel-depleted fields, or contraindications to free flap surgery. Although donor-site complications such as abdominal bulging and hernias remain concerns, outcomes have improved with mesh reinforcement and vascular delay techniques. Across included studies, aesthetic outcomes and patient satisfaction were high, and major complications were uncommon.

[CONCLUSIONS] The pTRAM flap remains a reliable and accessible choice for breast reconstruction, particularly in patients or settings where microsurgery is not feasible. Although deep inferior epigasetric perforator flaps provide superior muscle preservation, the pTRAM combines speed, safety, and predictable results, maintaining a significant role in modern reconstructive practice. Mastery of this technique facilitates the transition to advanced microsurgical procedures.