Partial Failure of free tram flap

Had my left breast reconstruction 22/12/14 free tram flap from abdomen within a couple of day 1/3 of the flap turned black and hard. I was using Bactroban with Inadine strips covered with Guaze daily but it didn’t seem to be making a difference. After 4 weeks 4 days 23/1/15 the PS carried out debridement of the affected area and now I have a KCI wound VAC to help heal faster, he thinks I will have for at least 4 weeks, after this heals he may have to do a skin graft but is not sure at this stage, PS said this could have happened because of the radiated skin causing issues with the blood vessels. Has anyone else had anything like this happen and if so, how long did it take to heal and also any tips on coping with the wound vac would be appreciated, thanks

Hi Crazybirdy


I myself have no experience of this but hoping to bump up your post for more responses.


Hugs Dee

Thanks Dee, much appreciated. I have searched the web and not found much info out there about skin necrosis, my PS said there is only a 3-5% failure rate with the flap. I have had problems with the wound vac as the pressure kept dropping so the district nurse had to come out and put more dressings over the wound making it even more uncomfortable :frowning: x

Dee, I have just read supertrouper posts which answers some questions I had. Thanks again

Hi Dee, I went to the hospital today to have the vac dressing changed and my PS had a quick look at the wound, he was concerned that part of the wound was not healing - to cut a long story short I am booked in for surgery on Monday 2/2/15 he said that although 85% of the flap had survived he could not take the risk of waiting longer, he wants to remove the flap and using skin from my back fit an expander and later on an implant. Worst case scenario if he is unable to do the LD back flap he will remove the complete tram flap and put the vac pump on again for it to heal. There is a very slim chance that he may be able to flip the tram flap over but it is only a slim chance. I’m so upset and disheartened I was so looking forward to this year and now it seems that all I have ahead of me is a longer recovery period and more scars and more surgery.

Thank you Dee and Kenstar,
big day tomorrow x

Thanks everyone for the well wishes and hugs, the operation didn’t go to plan so I ended up having the tram flap removed and the wound vac attached as my PS surgeon suspected an infection. I will get the results of the swabs tomorrow and if all ok I will have the LD flap and expander surgery on monday 9/2/15. I’m not sure how much more my body can take - that’s 3 major surgeries with 7 weeks.

Got the swab results which were all clear so am going in on Monday 9/2/15 for a LD back flap with expander, although if possible I’ve told PS that I would prefer a extended LD back flap without implant and lipofill at later date and he said this could be possible. Jillybee559 Walking definitely helps and it feels good to get out the house even just for 5 or 10 minutes. Thank you ladies for sharing your experiences and kind words x

Fingers and toes crossed for you. Hang on in there.

I am 3 days post surgery I ended up having a LD Flap with a little fat transfer and no implant or expander. I will see my PS soon to discuss what options are available. After what I’ve been through I just want to give my body a chance to recover first. Thanks everyone for your replies x