Optimizing Outcomes in Free Flap Breast Reconstruction in the Community Hospital Setting: A Stepwise Approach to DIEP/SIEA Flap Procedures with Banking a Hemiabdominal Flap
Nenhuma Miniatura disponível
Citações na Scopus
2
Tipo de produção
article
Data de publicação
2017
Editora
THIEME MEDICAL PUBL INC
Indexadores
Título da Revista
ISSN da Revista
Título do Volume
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
JOURNAL OF RECONSTRUCTIVE MICROSURGERY, v.33, n.7, p.474-482, 2017
Resumo
Background Free flap breast reconstruction is a conventional procedure in many countries; however, microvascular compromise remains a devastating outcome. Given the morbidity of total necrosis, optimizing free flap salvage stands out as an important area for research, especially among surgeons to overcome the learning curve period and in resource constrained scenario such as community hospitals. To ensure free deep inferior epigastric perforator (DIEP)/superficial inferior epigastric artery (SIEA) flap breast reconstruction, the authors present a technique involving raising a hemiabdominal flap as a free flap, and banking the remaining flap to be utilized if needed in a subsequent procedure. Methods A retrospective review was performed on all free flap breast reconstructions. In this period, 84 patients (mean age: 50.18 years) were included. Results In this study, 65.5% patients underwent immediate reconstruction, and 51.2% received DIEP reconstruction; 9.52% patients were returned to the operating room, and salvage reconstruction using the banked flap was performed in all patients. No differences were observed regarding early complications and age, body mass index, American Society of Anesthesiologists status, diabetes, smoking history, chemotherapy, radiotherapy, and type of flap used ( p >0.05). Hypertension was significantly associated with early complications ( p <0.05). Donor-site complications were associated with RT ( p <0.05). Conclusion The banked flap is a reliable method for ensuring DIEP/SIEA flap survival and should be considered in higher risk reconstructions and community hospitals. We believe that the present technique can be a good addition to the arsenal of plastic surgeons dealing with free flap breast reconstructions in selected patients.
Palavras-chave
breast reconstruction, microsurgery, outcome
Referências
- Alderman AK, 2002, PLAST RECONSTR SURG, V109, P2265, DOI 10.1097/00006534-200206000-00015
- Bodin F, 2015, ANN CHIR PLAST ESTH, V60, P171, DOI 10.1016/j.anplas.2015.02.005
- Chang EI, 2013, PLAST RECONSTR SURG, V131, p1E, DOI 10.1097/PRS.0b013e3182729d33
- Coroneos CJ, 2015, PLAST RECONSTR SURG, V135, p802E, DOI 10.1097/PRS.0000000000001150
- Duraes EFR, 2015, AESTHET PLAST SURG, V39, P694, DOI 10.1007/s00266-015-0534-4
- Fosnot J, 2011, PLAST RECONSTR SURG, V127, P496, DOI 10.1097/PRS.0b013e3181fed560
- Gill PS, 2004, PLAST RECONSTR SURG, V113, P1153, DOI 10.1097/01.PRS.0000110328.47206.50
- Gupta S, 2012, PROLOGUE INT WOUND J, V9, piii
- Hamdi M, 2010, PLAST RECONSTR SURG, V126, P375, DOI [10.1097/PRS.0b013e3181de22f3, 10.1097/PRS.0b013e3181de2213]
- Hofer SOP, 2007, ANN PLAS SURG, V59, P137, DOI 10.1097/01.sap.0000253326.85829.45
- Knight MAK, 2006, ANN PLAS SURG, V56, P593, DOI 10.1097/01.sap.0000202226.92967.f0
- Kovach SJ, 2006, ANN PLAS SURG, V57, P366, DOI 10.1097/01.sap.0000221983.23546.09
- Lakatta Edward G, 2002, Heart Fail Rev, V7, P29
- Laurent S, 2015, CIRC RES, V116, P1007, DOI 10.1161/CIRCRESAHA.116.303596
- Lineaweaver W, 2010, MICROSURG, V30, P61, DOI 10.1002/micr.20682
- Losken A, 2004, ANN PLAS SURG, V52, P258, DOI 10.1097/01.sap.0000110560.03010.7c
- Malyon AD, 2001, BRIT J PLAST SURG, V54, P227, DOI 10.1054/bjps.2000.3538
- Massenburg BB, 2015, AESTHET PLAST SURG, V39, P902, DOI 10.1007/s00266-015-0575-8
- Massenburg BB, 2015, J CRANIOFAC SURG, V26, pE679, DOI 10.1097/SCS.0000000000002138
- Mathes S J, 2006, PLASTIC SURG, P1083
- Munhoz AM, 2007, BREAST J, V13, P470, DOI 10.1111/j.1524-4741.2007.00467.x
- Munhoz AM, 2016, J PLAST RECONSTR AES, V69, P1087, DOI 10.1016/j.bjps.2016.01.019
- Munhoz Alexandre Mendonca, 2014, World J Clin Oncol, V5, P478, DOI 10.5306/wjco.v5.i3.478
- Munhoz AM, 2014, MICROSURG, V34, P217, DOI 10.1002/micr.22203
- Munhoz AM, 2011, AM J SURG, V202, P612, DOI 10.1016/j.amjsurg.2010.11.018
- Munhoz AM, 2004, PLAST RECONSTR SURG, V113, P517, DOI 10.1097/01.PRS.0000100812.37842.A8
- Petersen A, 2012, J PLAST SURG HAND SU, V46, P344, DOI 10.3109/2000656X.2012.700025
- Sacak B, 2015, J CRANIOFAC SURG, V26, P856, DOI 10.1097/SCS.0000000000001667
- Saint-Cyr M, 2007, PLAST RECONSTR SURG, V120, P1769, DOI 10.1097/01.prs.0000287132.35433.d6
- Salgado Christopher J, 2009, Plast Reconstr Surg, V124, pe295, DOI 10.1097/PRS.0b013e3181bcf07b
- Sanati-Mehrizy Paymon, 2015, Plast Reconstr Surg, V136, P18, DOI 10.1097/01.prs.0000472295.70072.45
- Sando IC, 2016, J RECONSTR MICROSURG, V32, P445, DOI 10.1055/s-0035-1571197
- Sarik JR, 2016, PLAST RECONSTR SURG, V137, p1E, DOI 10.1097/PRS.0000000000001852
- Selber JC, 2008, PLAST RECONSTR SURG, V122, P348, DOI 10.1097/PRS.0b013e31817d60b0
- Shridharani SM, 2009, MICROSURG, V29, P265, DOI 10.1002/micr.20611
- Sullivan SR, 2008, PLAST RECONSTR SURG, V122, P19, DOI 10.1097/PRS.0b013e3181774267
- Wang XL, 2014, AESTHET PLAST SURG, V38, P681, DOI 10.1007/s00266-014-0333-3
- Wormald JCR, 2014, J PLAST RECONSTR AES, V67, P143, DOI 10.1016/j.bjps.2013.10.024