TRAM vascular zones: the lower abdominal tissue that is transferred in a TRAM flap is divided into 4 zones based on degree of perfusion. Zone 1 has the best perfusion as it is the area directly over the deep inferior epigastric artery. Zone 2 is the area directly medial and has the second best perfusion. Zone 3 is the area lateral to zone 1 with a less robust blood supply than zone 2. Zone 4 is the area farthest from the pedicle and thus has the most tenuous blood supply. Because of its relatively poor perfusion, zone 4 is the first area discarded in flap transfer if debulking of the tissue block is necessary prior to inset
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