Figure 1.

The operative technique of the pedicled transverse rectus abdominis myocutaneous (TRAM) flap; (A) Preoperative planning photographs showing the area of flap design and the ipsilateral muscle pedicle site; (B) the upper abdominal flap is elevated above the fascia to the level of the costal margin. The lower abdominal skin flap is designed with the suprapubic skin crease, in line with the typical transverse cesarean section incision; (C) we leave 2 cm of the lateral anterior rectus fascia on the pedicle side and leave 1 cm of the linea alba or the first visible perforator; (D) the anterior fascia and rectus abdominis are transversely divided approximately 1 cm below the arcuate line; (E) we fixed the lateral remnant of the rectus sheath with 3 or 4 interrupted sutures at the edge of posterior layer and incorporated a part of an anterior layer of the rectus sheath; (F) the abdominal fascial defects plicated in two layers at the lateral margins of the rectus sheath; (G) immediate post-operative view after the pedicled TRAM flap; (H) the one-month postoperative follow-up.