Comparison of venous couplers versus hand‐sewn technique in 4577 cases of <scp>DIEP</scp>‐flap breast reconstructions – A multicenter study

Heidekrueger, Paul I.; Fritschen, Uwe von; Moellhoff, Nicholas; Germann, Günter; Giunta, Riccardo E.; Zeman, Florian; Prantl, Lukas

doi:10.1002/micr.30686

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…Patient data were obtained from the DGPRÄC national online registry for microsurgical breast reconstructions, including data sets from January 2011–July 2018. Parts of this database have been previously investigated by our study group [ 18 , 19 , 20 , 21 , 22 ]. Fritschen et al have described the purpose and design of the registry in detail [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

Heidekrueger

Moellhoff

Horch

et al. 2021

JCM

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While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.

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Section: Methodsmentioning

confidence: 99%

Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

Heidekrueger

Moellhoff

Horch

et al. 2021

JCM

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“…1). 15–91 A list of all included studies is available in Supplemental Digital Content 3. ( See table, Supplementary Digital Content 3 , which displays characteristics and references of all included studies.…”

Section: Resultsmentioning

confidence: 99%

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Kim

Yuan

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Breast reconstruction after mastectomy in breast cancer patients is known to provide significant improvements in psychological well-being. 1 Among various techniques available, the deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard for autologous breast reconstruction. 2 Despite the clinical importance and high regard of the DIEP flap technique, most research studies in leading plastic surgery journals are nonrandomized and observational in nature. 3 Nonrandomized observational studies on DIEP flap breast reconstruction have shown high risk of bias in their methodology. 2 Nonrandomized observational studies are generally considered to be of lesser quality evidence compared with randomized controlled trials (RCT) and systematic reviews/meta-analyses of RCTs. Nonetheless, observational studies are commonplace in plastic surgery. The prevalence of observational research, in part, is due to being less resource intensive and easier to conduct. 4 Other Breast Original articleBackground: The deep inferior epigastric artery perforator (DIEP) flap is widely used in autologous breast reconstruction. However, the technique relies heavily on nonrandomized observational research, which has been found to have high risk of bias. "Spin" can be used to inappropriately present study findings to exaggerate benefits or minimize harms. The primary objective was to assess the prevalence of spin in nonrandomized observational studies on DIEP reconstruction. The secondary objectives were to determine the prevalence of each spin category and strategy. Methods: MEDLINE and Embase databases were searched from January 1, 2015, to November 15, 2022. Spin was assessed in abstracts and full-texts of included studies according to criteria proposed by Lazarus et al. Results: There were 77 studies included for review. The overall prevalence of spin was 87.0%. Studies used a median of two spin strategies (interquartile range: 1-3). The most common strategies identified were causal language or claims (n = 41/77, 53.2%), inadequate extrapolation to larger population, intervention, or outcome (n = 27/77, 35.1%), inadequate implication for clinical practice (n = 25/77, 32.5%), use of linguistic spin (n = 22/77, 28.6%), and no consideration of the limitations (n = 21/77, 27.3%). There were no significant associations between selected study characteristics and the presence of spin. Conclusions:The prevalence of spin is high in nonrandomized observational studies on DIEP reconstruction. Causal language or claims are the most common strategy. Investigators, reviewers, and readers should familiarize themselves with spin strategies to avoid misinterpretation of research in DIEP reconstruction.

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“…However, the reduction in anastomosis time does not always translate to a reduction in operative time. For example, Heidekrueger and colleagues found that improvement in anastomosis time did not translate into reduction in total operative time in free flap breast reconstruction. Similar to this, the regression analyses in the current study regarding the use of venous coupler devices were not associated with a significant reduction in operative time when accounting for other variables.…”

Section: Discussionmentioning

confidence: 99%

Identifying Factors of Operative Efficiency in Head and Neck Free Flap Reconstruction

Alhefzi

Redwood

Hatchell

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceHead and neck oncological resection and reconstruction is a complex process that requires multidisciplinary collaboration and prolonged operative time. Numerous factors are associated with operative time, including a surgeon’s experience, team familiarity, and the use of new technologies. It is paramount to evaluate the contribution of these factors and modalities on operative time to facilitate broad adoption of the most effective modalities and reduce complications associated with prolonged operative time.ObjectiveTo examine the association of head and neck cancer resection and reconstruction interventions with operative time.Design, Setting, and ParticipantsThis large cohort study included all patients who underwent head and neck oncologic resection and free flap–based reconstruction in Calgary (Alberta, Canada) between January 1, 2007, and March 31, 2020. Data were analyzed between November 2021 and May2022.InterventionsThe interventions that were implemented in the program were classified into team-based strategies and the introduction of new technology. Team-based strategies included introducing a standardized operative team, treatment centralization in a single institution, and introducing a microsurgery fellowship program. New technologies included use of venous coupler anastomosis and virtual surgical planning.Main Outcomes and MeasuresThe primary outcome was mean operative time difference before and after the implementation of each modality. Secondary outcomes included returns to the operating room within 30 days, reasons for reoperation, returns to the emergency department or readmissions to hospital within 30 days, and 2-year and 5-year disease-specific survival. Multivariate regression analyses were performed to examine the association of each modality with operative time.ResultsA total of 578 patients (179 women [30.9%]; mean [SD] age, 60.8 [12.9] years) undergoing 590 procedures met inclusion criteria. During the study period, operative time progressively decreased and reached a 32% reduction during the final years of the study. A significant reduction was observed in mean operative time following the introduction of each intervention. However, a multivariate analysis revealed that team-based strategies, including the use of a standardized nursing team, treatment centralization, and a fellowship program, were significantly associated with a reduction in operative time.ConclusionsThe results of this cohort study suggest that among patients with head and neck cancer, use of team-based strategies was associated with significant decreases in operative time without an increase in complications.

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Comparison of venous couplers versus hand‐sewn technique in 4577 cases of DIEP‐flap breast reconstructions – A multicenter study

Cited by 13 publications

References 29 publications

Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Identifying Factors of Operative Efficiency in Head and Neck Free Flap Reconstruction

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