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

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Citações na Scopus
2
Tipo de produção
article
Data de publicação
2017
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
THIEME MEDICAL PUBL INC
Autores
Citação
JOURNAL OF RECONSTRUCTIVE MICROSURGERY, v.33, n.7, p.474-482, 2017
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
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
URI
https://observatorio.fm.usp.br/handle/OPI/21779
Referências
  1. Alderman AK, 2002, PLAST RECONSTR SURG, V109, P2265, DOI 10.1097/00006534-200206000-00015
  2. Bodin F, 2015, ANN CHIR PLAST ESTH, V60, P171, DOI 10.1016/j.anplas.2015.02.005
  3. Chang EI, 2013, PLAST RECONSTR SURG, V131, p1E, DOI 10.1097/PRS.0b013e3182729d33
  4. Coroneos CJ, 2015, PLAST RECONSTR SURG, V135, p802E, DOI 10.1097/PRS.0000000000001150
  5. Duraes EFR, 2015, AESTHET PLAST SURG, V39, P694, DOI 10.1007/s00266-015-0534-4
  6. Fosnot J, 2011, PLAST RECONSTR SURG, V127, P496, DOI 10.1097/PRS.0b013e3181fed560
  7. Gill PS, 2004, PLAST RECONSTR SURG, V113, P1153, DOI 10.1097/01.PRS.0000110328.47206.50
  8. Gupta S, 2012, PROLOGUE INT WOUND J, V9, piii
  9. Hamdi M, 2010, PLAST RECONSTR SURG, V126, P375, DOI [10.1097/PRS.0b013e3181de22f3, 10.1097/PRS.0b013e3181de2213]
  10. Hofer SOP, 2007, ANN PLAS SURG, V59, P137, DOI 10.1097/01.sap.0000253326.85829.45
  11. Knight MAK, 2006, ANN PLAS SURG, V56, P593, DOI 10.1097/01.sap.0000202226.92967.f0
  12. Kovach SJ, 2006, ANN PLAS SURG, V57, P366, DOI 10.1097/01.sap.0000221983.23546.09
  13. Lakatta Edward G, 2002, Heart Fail Rev, V7, P29
  14. Laurent S, 2015, CIRC RES, V116, P1007, DOI 10.1161/CIRCRESAHA.116.303596
  15. Lineaweaver W, 2010, MICROSURG, V30, P61, DOI 10.1002/micr.20682
  16. Losken A, 2004, ANN PLAS SURG, V52, P258, DOI 10.1097/01.sap.0000110560.03010.7c
  17. Malyon AD, 2001, BRIT J PLAST SURG, V54, P227, DOI 10.1054/bjps.2000.3538
  18. Massenburg BB, 2015, AESTHET PLAST SURG, V39, P902, DOI 10.1007/s00266-015-0575-8
  19. Massenburg BB, 2015, J CRANIOFAC SURG, V26, pE679, DOI 10.1097/SCS.0000000000002138
  20. Mathes S J, 2006, PLASTIC SURG, P1083
  21. Munhoz AM, 2007, BREAST J, V13, P470, DOI 10.1111/j.1524-4741.2007.00467.x
  22. Munhoz AM, 2016, J PLAST RECONSTR AES, V69, P1087, DOI 10.1016/j.bjps.2016.01.019
  23. Munhoz Alexandre Mendonca, 2014, World J Clin Oncol, V5, P478, DOI 10.5306/wjco.v5.i3.478
  24. Munhoz AM, 2014, MICROSURG, V34, P217, DOI 10.1002/micr.22203
  25. Munhoz AM, 2011, AM J SURG, V202, P612, DOI 10.1016/j.amjsurg.2010.11.018
  26. Munhoz AM, 2004, PLAST RECONSTR SURG, V113, P517, DOI 10.1097/01.PRS.0000100812.37842.A8
  27. Petersen A, 2012, J PLAST SURG HAND SU, V46, P344, DOI 10.3109/2000656X.2012.700025
  28. Sacak B, 2015, J CRANIOFAC SURG, V26, P856, DOI 10.1097/SCS.0000000000001667
  29. Saint-Cyr M, 2007, PLAST RECONSTR SURG, V120, P1769, DOI 10.1097/01.prs.0000287132.35433.d6
  30. Salgado Christopher J, 2009, Plast Reconstr Surg, V124, pe295, DOI 10.1097/PRS.0b013e3181bcf07b
  31. Sanati-Mehrizy Paymon, 2015, Plast Reconstr Surg, V136, P18, DOI 10.1097/01.prs.0000472295.70072.45
  32. Sando IC, 2016, J RECONSTR MICROSURG, V32, P445, DOI 10.1055/s-0035-1571197
  33. Sarik JR, 2016, PLAST RECONSTR SURG, V137, p1E, DOI 10.1097/PRS.0000000000001852
  34. Selber JC, 2008, PLAST RECONSTR SURG, V122, P348, DOI 10.1097/PRS.0b013e31817d60b0
  35. Shridharani SM, 2009, MICROSURG, V29, P265, DOI 10.1002/micr.20611
  36. Sullivan SR, 2008, PLAST RECONSTR SURG, V122, P19, DOI 10.1097/PRS.0b013e3181774267
  37. Wang XL, 2014, AESTHET PLAST SURG, V38, P681, DOI 10.1007/s00266-014-0333-3
  38. Wormald JCR, 2014, J PLAST RECONSTR AES, V67, P143, DOI 10.1016/j.bjps.2013.10.024

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/04
Artigos e Materiais de Revistas Científicas - ODS/03