Examples include the pedicled tram flap
, which takes the rectus abdominus muscle (or sit-up muscle) with it, containing the superior deep epigastric artery, and the latissimus dorsi myocutanous flap, which carries the thoracodorsal artery along with the latissimus muscle. The tram flap is used to create a breast out of abdominal skin and fat, while the latissimus flap is used to provide muscle and skin coverage over an expander or implant
. This is espiecially useful in a patient who has had radiation.
A free flap is a flap that has its original blood supply divided. The artery (and vein) to the flap is then connected to a new blood supply under the microscope. The new blood supply is usually the internal mammary artery, which runs lateral to the sternum or breast bone. The flap vessel used is the deep inferior epigastric pedicle (diep flap). This bloode vessel comes from below the abdomen and doesn't run through the sit-up muscle. The purpose of a free flap in breast reconstruction
is to improve circulation, and to prevent the side effects resulting from removing the sit-up muscle from the abdominal wall, which can lead to hernia
The free flap is a complicated procedure that should be done by a surgeon who has ecperience with this technique.