DELAYED TRAM FLAP FOR EXTENSIVE SOFT TISSUE DEFECTS AFTER MASTECTOMY: A TIME-EFFICIENT ALTERNATIVE TO FREE DIEP FLAP IN RESOURCE-LIMITED SETTINGS

Abstract

Objective: To prospectively compare flap survival and total length of operating time between delayed Transverse Rectus Abdominis Myocutaneous (TRAM) flap and Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction in patients who have undergone mastectomy.

Design: quasi-experimental study

Place and Duration of study: Department of Plastic Surgery, Lahore General Hospital, Lahore. From 20^th November, 2025 to 20^th April, 2026

Methodology: Two equal groups of 50 patients, with post mastectomy wounds with ages ranging from 33 to 54 years old were divided by researchers discretion (non Probability convenience sampling).  Group A had breast reconstruction using Delayed TRAM flap whereas in Group B DIEP flap was performed. For statistical analysis was performed using SPSS version 29. Chi square and Fisher’s exact tests were used to examine categorical variables. The independent sample t-test was used to examine continuous data and their means. The Shapiro-Wilk test was used to check normality. Results were presented with p-value <0.05, 95% confidence interval and power of 80%.

Results: The mean age was 41.18±8.03 years for Delayed TRAM flap and 44.96±9.52 years for DIEP flap. Mean wound size of 131.50±39.74 for Delayed TRAM flap and 126.56 ± 35.68 for DIEP flap. The Delayed TRAM flap demonstrated a significantly shorter mean operative time (303.68 ± 66.47min) compared to the DIEP flap (387.84 ± 69.53 min, p<0.0001). Flap survival was 96% in the Delayed TRAM group. The DIEP group had a 92% survival rate, with 3(6.0%) resulting in partial flap loss and 1(2.0%) resulting in complete flap failure.

Conclusion: The Delayed TRAM flap is a highly time-efficient and reliable alternative for post-mastectomy reconstruction. It provides superior vascular robustness and significantly reduced surgical duration, making it an ideal alternative for high-volume, resource-constrained surgical departments.