Free Tissue Transfer in the Obese Patient

Fischer, John P.; Nelson, Jonas A.; Sieber, Brady A.; Cleveland, Emily C.; Kovach, Stephen J.; Wu, Liza C.; Serletti, Joseph M.; Kanchwala, Suhail

doi:10.1097/prs.0b013e31828e2159

Cited by 92 publications

(19 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Numerous studies have confirmed that obese patients experience increased surgical complications, specifically wound healing complications. 3,4,11,14,17,[22][23][24][25] Wound healing complications in obesity have been linked to decreased myofibroblast activity and disrupted collagen maturation. 26,27 Fischer et al concluded that wound healing complications in obese patients are likely related to increased tissue tension, attenuated wound healing capacity, and extensive dissections required for flap harvest.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 Fischer et al concluded that wound healing complications in obese patients are likely related to increased tissue tension, attenuated wound healing capacity, and extensive dissections required for flap harvest. 23 A multivariate regression model was created to control for confounding factors and to assess whether obesity carries an intrinsic risk for any postoperative complication following free flaps. The most significant odds for any complication were in class II (OR: 1.23; p ¼ 0.004) and III obesity (OR: 1.45, p < 0.001) groups.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Body Mass Index on Free Flap Breast Reconstruction

Sudduth

Marquez

Samlowski

et al. 2023

J Reconstr Microsurg

View full text Add to dashboard Cite

Background Literature addressing the risks associated with increasing body mass index (BMI) for patients undergoing free flap breast reconstruction is limited. Often, an arbitrary BMI cutoff (i.e., BMI of 30 kg/m2) is used to determine candidacy for a free flap without substantial backing evidence. This study utilized a national multi-institutional database to analyze outcomes of free flap breast reconstruction and stratified complications by BMI class. Methods Using the 2010 to 2020 National Surgical Quality Improvement Program database, patients who underwent free flap breast reconstruction were identified. Patients were divided into six cohorts based on the World Health Organization BMI classes. Cohorts were compared by basic demographics and complications. A multivariate regression model was created to control for age, diabetes, bilateral reconstruction, American Society of Anesthesiologists class, and operative time. Results Surgical complications increased with each BMI class, with the highest rates occurring in class I, II, and III obesity, respectively. In a multivariable regression model, the risk for any complication was significant for class II and III obesity (odds ratio [OR]: 1.23, p < 0.004; OR: 1.45, p < 0.001, respectively). Diabetes, bilateral reconstruction, and operative time were independently associated with an increased risk of any complication (OR: 1.44, 1.14, 1.14, respectively, p < 0.001). Conclusion This study suggests that the risks of postoperative complications following free flap breast reconstruction are highest for patients with a BMI greater than or equal to 35 kg/m2, having nearly 1.5 times higher likelihood of postoperative complications. Stratifying these risks by weight class can help guide preoperative counseling with patients and help physicians determine candidacy for free flap breast reconstruction.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effect of Body Mass Index on Free Flap Breast Reconstruction

Sudduth

Marquez

Samlowski

et al. 2023

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…The surgical group will be further subdivided into intraoperative and post-operative. Complications will be strati ed according to the Clavien-Dindo classi cation (30)(31)(32). Finally, if available any assessment of pre-operative tness will be recorded.…”

Section: Secondary Outcomesmentioning

confidence: 99%

Protocol for a Systematic Review of Outcomes From Microsurgical Free Tissue Transfer Performed on Short-term Surgical Missions in Low-income and Middle-income Countries

Berker

Čebron

Bradley

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: In many units around the world, microsurgical free tissue transfer represents the gold standard for reconstruction of significant soft tissue defects following cancer, trauma or infection. However, many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources, infrastructure or training required to perform any microsurgical procedures. Long-term international collaborations have been formed with annual short-term reconstructive missions conducting microsurgery. In the first instance, these provide reconstructive surgery to those who need it. In the longer-term, they offer an opportunity for teaching and the development of sustainable local services.Methods: A PRISMA-compliant systematic review and meta-analysis will be performed. A comprehensive, predetermined search strategy will be applied to the MEDLINE and Embase electronic databases from inception to December 2020. All clinical studies presenting sufficient data on free tissue transfer performed on short-term surgical missions (STSMs) in LMICs will be eligible for inclusion. The primary outcomes are rate of free flap failure, rate of emergency return to theatre for free flap salvage and successful salvage rate. The secondary outcomes include postoperative complications and any functional or patient reported outcome measures. Screening of studies, data extraction and assessments of study quality and bias will be conducted by two authors. Individual study quality will be assessed according to the Oxford Evidence-based Medicine Scales of Evidence 2, and risk of bias using either the ‘Revised Cochrane risk of bias tool for randomized trials’ (Rob2), or the ‘Risk of bias in non-randomized studies of interventions’ (ROBINS-I) tools. Overall strength of evidence will be assessed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.Discussion: To-date the outcomes of microsurgical procedures performed on STSMs to LMICs are largely unknown. Improved education, funding and allocation of resources are needed to support surgeons in LMICs to perform free tissue transfer. STSMs provide a vehicle for sustainable collaboration and training. Disseminating microsurgical skills could improve the care received by patients living with reconstructive pathology in LMICs, but this is poorly established. This study sets out a robust protocol for a systematic review designed to critically analyse outcomes. Systematic review registration: Submitted to PROSPERO (15/12/20 ID: 225613)

show abstract

“…The surgical group will be further subdivided into intraoperative and post-operative. Complications will be stratified according to the Clavien-Dindo classification [35][36][37]. Finally, if available any assessment of preoperative fitness will be recorded.…”

Section: Secondary Outcomesmentioning

confidence: 99%

Protocol for a systematic review of outcomes from microsurgical free-tissue transfer performed on short-term collaborative surgical trips in low-income and middle-income countries

et al. 2021

View full text Add to dashboard Cite

Background In many units around the world, microsurgical free-tissue transfer represents the gold standard for reconstruction of significant soft tissue defects following cancer, trauma or infection. However, many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources, infrastructure or training required to perform any microsurgical procedures. Long-term international collaborations have been formed with annual short-term reconstructive missions conducting microsurgery. In the first instance, these provide reconstructive surgery to those who need it. In the longer-term, they offer an opportunity for teaching and the development of sustainable local services. Methods A PRISMA-compliant systematic review and meta-analysis will be performed. A comprehensive, predetermined search strategy will be applied to the MEDLINE and Embase electronic databases from inception to August 2021. All clinical studies presenting sufficient data on free-tissue transfer performed on short-term collaborative surgical trips (STCSTs) in LMICs will be eligible for inclusion. The primary outcomes are rate of free flap failure, rate of emergency return to theatre for free flap salvage and successful salvage rate. The secondary outcomes include postoperative complications, cost effectiveness, impact on training, burden of disease, legacy and any functional or patient reported outcome measures. Screening of studies, data extraction and assessments of study quality and bias will be conducted by two authors. Individual study quality will be assessed according to the Oxford Evidence-based Medicine Scales of Evidence 2, and risk of bias using either the ‘Revised Cochrane risk of bias tool for randomized trials’ (Rob2), the ‘Risk of bias in non-randomized studies of interventions’ (ROBINS-I) tool, or the National Institute for Health Quality Assessment tool for Case Series. Overall strength of evidence will be assessed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Discussion To-date the outcomes of microsurgical procedures performed on STCSTs to LMICs are largely unknown. Improved education, funding and allocation of resources are needed to support surgeons in LMICs to perform free-tissue transfer. STCSTs provide a vehicle for sustainable collaboration and training. Disseminating microsurgical skills could improve the care received by patients living with reconstructive pathology in LMICs, but this is poorly established. This study sets out a robust protocol for a systematic review designed to critically analyse outcomes. Systematic review registration PROSPERO 225613

show abstract

Free Tissue Transfer in the Obese Patient

Abstract: Risk, II.

Cited by 92 publications

References 25 publications

The Effect of Body Mass Index on Free Flap Breast Reconstruction

The Effect of Body Mass Index on Free Flap Breast Reconstruction

Protocol for a Systematic Review of Outcomes From Microsurgical Free Tissue Transfer Performed on Short-term Surgical Missions in Low-income and Middle-income Countries

Protocol for a systematic review of outcomes from microsurgical free-tissue transfer performed on short-term collaborative surgical trips in low-income and middle-income countries

Contact Info

Product

Resources

About