Increasing abdominal wall thickness predicts complications in abdominally based breast reconstruction: A review of 106 consecutive patients

Boehm, Lucas; Hettinger, Patrick; LoGiudice, John; Doren, Erin L.

doi:10.1016/j.bjps.2019.11.012

Cited by 7 publications

(7 citation statements)

References 34 publications

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“…In our cohort, ASFT did not correlate with any other complications, which conflicts with previous studies that have approximated abdominal subcutaneous fat with various measurements. In a comparable radiographic analysis, Boehm et al (2020) found correlations with delayed wound healing, which we did not include in our analysis. On the contrary, in a small sample of 58 patients, Levi et al (2014) did not find a statistically significant association between subcutaneous fat and donor site dehiscence.…”

Section: Discussionmentioning

confidence: 93%

“…Finding an alternative way to more directly account for abdominal subcutaneous fat content may provide a more effective manner by which to preoperatively evaluate patients undergoing abdominally based autologous breast reconstruction. Though studies have attempted to achieve this in the past, they were limited by a small sample size or a relatively low average BMI; our study of over 300 patients is the largest cohort studied to date and reflects a high average BMI among patients (Boehm et al, 2020; Modarressi et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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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“…Therefore, in both univariable and multivariable analyses, there were no significant differences in these characteristics. It was reported that obese patients delayed abdominal wound healing in free abdominal flap surgery (Boehm et al, 2020). Therefore, because the rate of obesity in patients with fat necrosis was high, the abdominal wound healing delay rate was also high.…”

Section: Discussionmentioning

confidence: 99%

“…It was reported that obese patients delayed abdominal wound healing in free abdominal flap surgery (Boehm et al, 2020). Therefore, because the rate of obesity in patients with fat necrosis was high, the abdominal wound healing delay rate was also high.…”

Section: Discussionmentioning

confidence: 99%

The correlation of flap blood glucose with fat necrosis of free abdominal flap for unilateral breast reconstruction

et al. 2022

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Background: Flap blood glucose (FBG) measurement is proposed as a monitoring technique. A cause of long-lasting fever could be derived from fat necrosis. If the findings of low FBG correlated with fat necrosis, it could predict the poor cosmetic result and a source of fever. However, this correlation remained unsolved. The purpose of this study was to clarify this correlation in breast reconstruction.Methods: In the 180 unilateral breast cancer patients (mean age = 49.8 years) performed free abdominal flap, we retrospectively compared the group where fat necrosis occurred with the group where it did not occur (45 patients with fat necrosis vs. 135 patients without). We compared the average of FBG in each postoperative day. Results:The average FBG was significantly lower in patients with fat necrosis in the second postoperative day (115.3 ± 27.3 vs. 126.3 ± 13.7 mg/dl, p = .026) and the third postoperative day (111.1 ± 22.1 vs. 118.8 ± 13.8 mg/dl, p = .036). Mean BMI and inserted total flap weight were significantly higher in patients with the fat necrosis group (24.8 vs. 22.9 kg/m 2 , p = .005) (617 vs. 478 g, p = .006). The multivariate analysis revealed early FBG (OR = 0.96, p = .0002) and laterality (right side) (OR = 0.46, p = .043) were independently significant predictors. There were no significant between-group differences regarding other factors (age, systemic blood glucose, comorbidities and operative details). Conclusions:The possibility of fat necrosis was high for patients with low FBG in the early postoperative day. | INTRODUCTIONFlap necrosis, either partial or complete, is a major complication of autologous breast reconstruction. There has also been notable progress regarding surgical techniques and flap design for breast reconstruction using free abdominal flaps (Grover et al., 2014;Rothenberger et al., 2013). Furthermore, knowledge of regional vascular anatomy has improved and various classifications for free abdominal flap perfusion have been implemented (Hartrampf et al., 1982;

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“…Complete wound closure will be achieved after about eight days [ 22 ]. Furthermore, recent studies point out abdominal wall fat thickness as an important predictor of SSI [ 23 ], even in wounds after surgeries distant from the abdominal wall [ 24 ]. Additionally, it appears that an increased visceral fat area on CT scans also predicts SSI after gastrectomies [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Modified Incisional Negative Pressure Wound Therapy Increases Seroma Evacuation: An Ex Vivo Model

Jansen-Winkeln

2021

BioMed Research International

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Background. Incisional negative wound pressure therapy (iNPWT) is a relatively novel dressing technique with the aim of reducing postoperative wound infections and dehiscence in high-risk wounds after all kinds of surgical procedures. There is a lack of theoretical knowledge about the way those dressing would ameliorate wound healing. One aspect is the reduction of superficial tension, but significant remaining seroma might still cause deep wound infections. The aim of this study was the evaluation of technical modifications of the standard iNPWT dressing to increase seroma evacuation. Methods. iNPWT dressings were applied on the porcine abdominal wall, and an incremental pressure ramp from 50 to 200 mmHg was performed. The resulting wound pressures were measured using (i) balloon manometry and (ii) esophageal manometry catheter. Seroma evacuation was analyzed with a seroma model. All measurements were performed with (i) standard iNPWT dressing, (ii) wound gauze diverted through the incision, and (iii) placement of suction drain tube into iNPWT. Results. Due to the modifications of the iNPWT dressing, the vacuum applied by the iNPWT dressing could be transferred into the wound and was not only restricted to superficial layers. More importantly, placement of wound gauzes or suction drain tubes led to complete extraction of wound seroma. The placement of the suction drain tube showed the best combination of increased intrawound pressure as well as seroma evacuation. Conclusion. Addition of a suction drain tube to the iNPWT dressing leads to an improved function of the iNPWT dressing in our ex vivo model.

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Increasing abdominal wall thickness predicts complications in abdominally based breast reconstruction: A review of 106 consecutive patients

Cited by 7 publications

References 34 publications

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

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

The correlation of flap blood glucose with fat necrosis of free abdominal flap for unilateral breast reconstruction

Modified Incisional Negative Pressure Wound Therapy Increases Seroma Evacuation: An Ex Vivo Model

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