Microvascular Breast Reconstruction in the Diabetic Patient

Miller, Randy B.; Reece, Gregory P.; Kroll, Stephen S.; Chang, David W.; Langstein, Howard N.; Ziogas, Argyrios; Robb, Geoffrey L.; Evans, Gregory R. D.

doi:10.1097/01.prs.0000244745.21562.58

Cited by 46 publications

(25 citation statements)

References 28 publications

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“…Additionally, several studies of other flap procedures have found that diabetes is not associated with a significantly increased wound complication rate. 27,28 Regarding malnutrition, the albumin and prealbumin levels we selected as the definition of malnutrition, 3.5 mg/dL and 18 mg/dL, respectively, may not accurately identify the level of malnourishment necessary to produce an adverse wound healing environment. These values were chosen because they represent the lower limit of normal on our institution's laboratory-reporting software.…”

Section: Discussionmentioning

confidence: 99%

Paraspinous Muscle Flap Reconstruction of Complex Midline Back Wounds

Mericli

Tarola

Moore

et al. 2010

Annals of Plastic Surgery

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With increasingly complex spine surgeries now being performed on a more comorbid patient population, the reconstruction of midline back wounds from these procedures is becoming a frequent dilemma encountered by plastic surgery. The purpose of this study is to examine the effect of various preoperative risk factors on postoperative wound healing complications after paraspinous muscle flap reconstruction of midline back defects. An Institutional Review Board-approved, 11-year, retrospective, office and hospital chart review was conducted. All adult patients who underwent paraspinous muscle flap reconstruction during the study period were included. There were 92 patients in the study, representing the largest reported series to-date for the paraspinous muscle flap procedure. Mean follow-up was 120 days. Several wound-healing risk factors were present in this patient population: 72% were malnourished, 41% had hypertension, 37% were obese, 34% had a history of smoking, 32% had diabetes, 16% were on chronic steroids, 14% had a history of more than 2 previous spine surgeries, and 9% had a history of radiation to the wound area. Factors significantly (P < 0.05) associated with postreconstruction wound complications included history of traumatic spine injury, prereconstruction hardware removal, a history of more than 2 spine surgeries, hypertension, and lumbar wound location. This patient population possesses multiple comorbidities making complex wound healing difficult. Several specific risk factors are associated with an increased rate of postreconstruction wound complications after paraspinous muscle flaps. The paraspinous muscle flap remains an important tool for spinal wound reconstruction in the reconstructive surgeon's armamentarium.

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Section: Discussionmentioning

confidence: 99%

Paraspinous Muscle Flap Reconstruction of Complex Midline Back Wounds

Mericli

Tarola

Moore

et al. 2010

Annals of Plastic Surgery

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“…In contrast, Miller et al found no increase in free transverse rectus abdominis myocutaneous (TRAM) flap or donor-site complications between type 1 diabetic, type 2 diabetic, and nondiabetic patients (Level II Evidence) 38. Other studies examining diabetes and surgical complications have not achieved statistical significance (Level I/II Evidence) 24,29,39.…”

mentioning

confidence: 91%

Evidence to Support Controversy in Microsurgery

Fan

Patel

Mardini

et al. 2015

Plastic and Reconstructive Surgery

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Microsurgery practice, including preoperative patient selection, intraoperative technique, and anesthetic considerations, varies from institution to institution and from surgeon to surgeon. Many surgeons' practices are driven by "conventional wisdom," which is handed down from mentors to fellows and residents. In this article, the authors explore the oxymoron that there is evidence to support controversy in microsurgery. Indeed, if there was convincing evidence to support varying microsurgery practices, there would be no controversy. The authors conducted a review with a focus on evidence-based medicine to support microsurgery practice.

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“…Several studies have examined the relationship between several patient characteristics (other than adjuvant therapy) and complications (2,6,(42)(43)(44)(45), but there was variation in the factors studied, and inconclusive results.…”

Section: The Effect Of Patient Characteristics On Breast Reconstructionmentioning

confidence: 99%

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

et al. 2017

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being, health-related quality of life and satisfaction (5,7-10).Patients' satisfaction and health-related quality of life are frequently used as parameters for outcome measurement in plastic surgery. Postoperative complications after breast reconstruction are common and affect patient satisfaction.Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially.Conclusions: Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.

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Microvascular Breast Reconstruction in the Diabetic Patient

Abstract: The present data indicate that type 1 diabetes mellitus and type 2 diabetes mellitus are not relative or absolute contraindications to microvascular TRAM flap breast reconstruction.

Cited by 46 publications

References 28 publications

Paraspinous Muscle Flap Reconstruction of Complex Midline Back Wounds

Paraspinous Muscle Flap Reconstruction of Complex Midline Back Wounds

Evidence to Support Controversy in Microsurgery

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

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