Since the DIEP flap involves microsurgery and the TRAM flap does not, shouldn the risk be greater for a DIEP flap?
No. In the hands of a well-trained and experienced microsurgeon, the microsurgery should not pose a problem. The better blood supply to the flesh of the lower abdomen comes from the blood vessel to the lower abdomen and these are the vessels utilized in a DIEP flap. This leads to a healthier piece of flesh. In the TRAM flap, while no microsurgery is utilized, the blood supply is not as vigorous. This is because the included blood vessels in the muscle are from the upper abdomen and obviously their contribution to the blood supply of the lower abdominal tissue is less.
