DIEP flap for breast reconstruction: Is abdominal fat thickness associated with post-operative complications?

M, Ali; Müller, C.; Montet, Xavier; Rüegg, Eva Meia; Pittet‐Cuénod, Brigitte

doi:10.1016/j.bjps.2017.05.002

Cited by 30 publications

(23 citation statements)

References 17 publications

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“…A total of 697 studies were identified. Of these, 12 studies (including 1756 patients) evaluated adjuvant radiotherapy (350 patients), neoadjuvant radiotherapy (723) and no radiotherapy (683) ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

“…There were three prospective study designs and nine that were retrospective, but no RCTs. There were two multicentre (1 prospective and 1 retrospective) and ten single‐centre studies (2 prospective and 8 retrospective) ( Table ). Study quality (GRADE) was low in eight studies and moderate in the other four, with an overall high risk of bias.…”

Section: Resultsmentioning

confidence: 99%

“…There were two multicentre (1 prospective and 1 retrospective) and ten single‐centre studies (2 prospective and 8 retrospective) ( Table ). Study quality (GRADE) was low in eight studies and moderate in the other four, with an overall high risk of bias. A summary of baseline characteristics, including numbers of centres, country of origin, dates, patient numbers, breast cancer pathology and adjuvant medical treatments in comparative adjuvant and neoadjuvant radiotherapy groups, including non‐comparative studies, is provided in Table S1 (supporting information).…”

Section: Resultsmentioning

confidence: 99%

“…No study prospectively graded surgical complications according to an accepted classification such as CDC (fat necrosis, partial or total flap loss, infection and wound complications). One study graded partial flap loss using a novel flap necrosis classification system, adapted from Kwok et al …”

Section: Resultsmentioning

confidence: 99%

“…In one, it was not possible to determine whether fat necrosis required surgical revision for each radiotherapy group (adjuvant or neoadjuvant), compared with no radiotherapy. A second omitted individual abdominal complications relative to timings of radiotherapy, and the third omitted overall numbers of complications. Reviewed studies also failed to define postoperative wound infections according to Centers for Disease Control and Prevention criteria.…”

Section: Discussionmentioning

confidence: 99%

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Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes

et al. 2019

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Background Effects of postmastectomy radiotherapy (PMRT) on autologous breast reconstruction (BRR) are controversial regarding surgical complications, cosmetic appearance and quality of life (QOL). This systematic review evaluated these outcomes after abdominal free flap reconstruction in patients undergoing postoperative adjuvant radiotherapy (PMRT), preoperative radiotherapy (neoadjuvant radiotherapy) and no radiotherapy, aiming to establish evidence‐based optimal timings for radiotherapy and BRR to guide contemporary management. Methods The study was registered on PROSPERO (CRD42017077945). Embase, MEDLINE, Google Scholar, CENTRAL, Science Citation Index and ClinicalTrials.gov were searched (January 2000 to August 2018). Study quality and risk of bias were assessed using GRADE and Cochrane's ROBINS‐I respectively. Results Some 12 studies were identified, involving 1756 patients (350 PMRT, 683 no radiotherapy and 723 neoadjuvant radiotherapy), with a mean follow‐up of 27·1 (range 12·0–54·0) months for those having PMRT, 16·8 (1·0–50·3) months for neoadjuvant radiotherapy, and 18·3 (1·0–48·7) months for no radiotherapy. Three prospective and nine retrospective cohorts were included. There were no randomized studies. Five comparative radiotherapy studies evaluated PMRT and four assessed neoadjuvant radiotherapy. Studies were of low quality, with moderate to serious risk of bias. Severe complications were similar between the groups: PMRT versus no radiotherapy (92 versus 141 patients respectively; odds ratio (OR) 2·35, 95 per cent c.i. 0·63 to 8·81, P = 0·200); neoadjuvant radiotherapy versus no radiotherapy (180 versus 392 patients; OR 1·24, 0·76 to 2·04, P = 0·390); and combined PMRT plus neoadjuvant radiotherapy versus no radiotherapy (272 versus 453 patients; OR 1·38, 0·83 to 2·32, P = 0·220). QOL and cosmetic studies used inconsistent methodologies. Conclusion Evidence is conflicting and study quality was poor, limiting recommendations for the timing of autologous BRR and radiotherapy. The impact of PMRT and neoadjuvant radiotherapy appeared to be similar.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes

et al. 2019

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Abdominal subcutaneous fat thickness as a substitute for BMI in predicting complications in abdominally‐based autologous breast reconstruction

et al. 2021

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Introduction Patient selection for autologous tissue transfer for postmastectomy breast reconstruction often utilizes body mass index (BMI) to risk stratify patients, though it only estimates fat content and does not address fat distribution. This study aims to identify a measurement of abdominal subcutaneous fat thickness (ASFT) from preoperative computed tomography (CT) angiography imaging to better predict complications. Methods A retrospective review of patients who underwent an abdominal microvascular free flap breast reconstruction was performed. The average of the bilateral distances from the lateral border of the rectus abdominus to the most proximal point of the dermis at the L4–L5 space was measured on preoperative imaging to estimate ASFT. This measurement was compared to BMI in regards to correlation with any complication, major or minor complications, and donor or recipient site complications. Statistical analysis utilized point‐biserial correlations and multivariable logistic regression analyses. Results Three hundred and nine cases comprising a total of 496 breast reconstructions were identified. BMI did not correlate with any of the grouped complications, while ASFT correlated with occurrence of any complication (p = .003), minor complications (p = .001), and recipient site complications (p = .001). Further analysis revealed ASFT is specifically correlated with fat necrosis (p = .005). In independent multivariable regression models, both BMI (p = .011) and ASFT (p = .001) were significant predictors of fat necrosis. The ASFT model had a BIC of 335.42 compared to the BMI model with a value of 340.89, with smaller numbers representing more predictive models. Conclusion Estimation of ASFT is easily performed and is a significantly better predictor of flap fat necrosis than BMI.

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Correlation between obesity‐related measurements and initial and initial resting intravesical and abdominal pressures in urodynamic study using air‐filled catheter system

Shen,

Zeng,

Zhang

et al. 2023

Neurourology and Urodynamics

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ObjectivesTo establish the initial (before pressure equilibrium) and initial resting intravesical and abdominal pressure in the sitting position using air‐filled catheters, to assess the correlation between these pressures and obesity‐related measurements, and to estimate if obesity‐related measurements can be a guide to interpret initial and initial resting pressures in urodynamic testing.MethodsPatients with non‐neurogenic lower urinary tract symptoms referred for urodynamic testing in our center were consecutively enrolled in a prospective study from August 2022 to October 2022. The correlation between the initial and initial resting pressures (before and after pressure equilibrium) and obesity‐related measurements were analyzed using Pearson's correlation coefficient and multiple linear regression analysis.ResultsNinety‐eight patients aged 56 ± 16 were studied. The 95% range of the initial intravesical and abdominal pressure were 18–42 cmH2O and 21–60 cmH2O, respectively. The initial resting intravesical, abdominal, and detrusor pressure in the 95% range were 17–41, 16–42, and −5 to 4 cmH2O, respectively. Over the multiple analysis, abdominal fat thickness, and body mass index (BMI) correlated independently with initial intravesical pressure, and only visceral fat grade correlated with initial abdominal pressure. BMI correlated independently with initial resting intravesical pressure.ConclusionsOur results determined the ranges of values of both initial and initial resting pressures in the air‐charged system. Meanwhile, the present study indicated the obesity‐related measurements may be used as a guide to interpret the initial and initial resting pressures in urodynamic testing, and may provide a reference for the quality control of these pressures.

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DIEP flap for breast reconstruction: Is abdominal fat thickness associated with post-operative complications?

Cited by 30 publications

References 17 publications

Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes

Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes

Abdominal subcutaneous fat thickness as a substitute for BMI in predicting complications in abdominally‐based autologous breast reconstruction

Correlation between obesity‐related measurements and initial and initial resting intravesical and abdominal pressures in urodynamic study using air‐filled catheter system

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