Risk factors and blood flow in free TRAM flap vertical laparotomy scar and a disproportional abdominal mass compared with the volume needed for breast reconstruction. These patients were excluded because the blood‐flow‐measurement location was expected to be discarded (medial border of zone IV). In addition, only patients with a secondary breast reconstruction with no surplus of skin at the recipient site were included. These inclusion criteria resulted in preservation of the measurement sites in zone I and zone IV in the reconstructed breast. As a result, all patients who were included in the study had zones I‐III and zone IV to a variable degree, depending on the volume needed for reconstruction (Figure 5.1). Flap blood‐ flow zones were named in accordance to our own clinical experience and recent literature, with zones I and II on the ipsilateral side of donor vessels and III and IV on the contralateral side.25 Figure 5.1 Zone classification and LDF measurement sites. I–IV, Blood flow zones. The black point within the circle represents the laser Doppler flowmetry sites. Ipsilateral to the vascular pedicle, the LDF probe holder in zone I is sutured between the medial and lateral row of the perforators, whereas the second holder is sutured at the medial border in zone IV. The shaded area represents the part of the flap (zones III and IV), which was discarded to a variable degree, depending on the volume needed for reconstruction. Operations were performed by experienced plastic surgeons. The muscle‐sparing free TRAM flap was used in all patients for breast reconstruction; with this procedure, a small medial part of the rectus abdominis was harvested, along with several lateral (2‐3) and medial (1–2) perforators.26 In all patients, the internal mammary vessels were used for the anastomosis. Factors used for analysis included patients’ age and obesity, defined in body mass index (BMI) subgroups of 25–30, and >30. History of radiotherapy, chemotherapy, and tobacco use (defined as active smoking on preoperative day) was recorded. Flap weight 73
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