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Recovery After Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction Surgery

Deena Damsky Dell
Carolyn Weaver
Jeannie Kozempel
Andrea Barsevick
ONF 2008, 35(2), 189-196 DOI: 10.1188/08.ONF.189-196

Purpose/Objectives: To assess pain and activity limitations and to determine realistic goals for recovery after a transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction in a standard rehabilitation and recovery program. Assessing patient satisfaction with educational information is a secondary objective.

Design: Before and after comparison.

Setting: A National Cancer Institute-designated comprehensive cancer center in the mid-Atlantic United States.

Sample: 16 women who had TRAM flap breast reconstruction.

Methods: Data were collected before surgery and four and eight weeks after surgery using an adapted Brief Pain Inventory, a recovery and rehabilitation assessment, and an evaluation of patient satisfaction.

Main Research Variables: Presence of pain; disruption of activities, relationships, and mood because of pain; pain relief measures; active range of motion; muscle strength; and satisfaction with educational information.

Findings: Pain and activity limitation scores were elevated four weeks after surgery and returned almost to baseline at eight weeks. Abdominal pain was significantly higher for women with free versus pedicled TRAM flap surgery, and women with previous back pain reported more lower back pain after surgery. Opioids, followed by nonsteroidal antiinflammatory drugs, were the most common pain relief method. Active range of motion and muscle strength showed no significant limitations at eight weeks. Patients were very satisfied with the educational information provided by nurses and physical therapists.

Conclusions: Women can expect to have some pain and activity limitations four weeks after surgery but will be almost fully recovered at eight weeks. Educational information on pain management and resuming an active lifestyle were useful.

Implications for Nursing: Nurses and physical therapists can positively influence recovery from TRAM flap breast reconstruction by educating patients.

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