Elevating the island: the simplest method of delaying the TRAM flap.

Vascular compromise is a relatively frequent complication of breast reconstruction performed with the use of pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps. The authors present their experience in delaying TRAM flaps by preelevating the island 7 to 10 days before flap transfer. The skin island is fully incised and raised from the lateral tip to the lateral border of the rectus muscle on one side, and is raised from the tip to the midline on the opposite side.