Morbidity of the Donor Site and Complication Rates of Breast Reconstruction with Autologous Abdominal Flaps: A Systematic Review and Meta-Analysis

Mortada, Hatan; AlNojaidi, Taif Fawaz; AlRabah, Razan; Almohammadi, Yousif; AlKhashan, Raghad; Aljaaly, Hattan

doi:10.1155/2022/7857158

Cited by 15 publications

(12 citation statements)

References 58 publications

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“…This includes early complications within 30 days as well as later sequelae such as surgical correction of abdominal bulge or hernia. Traditional free TRAM flaps yielded the largest abdominal donor-site morbidity and have largely fallen out of favor for DIEP flaps, which are less likely to create hernias and bulging given increased preservation of the rectus abdominus 28–30 . With inclusion of mesh for donor-site repair, Wan et al 30 showed a reduction in hernia and bulge rates for free and muscle-sparing TRAM flaps to approximately 4%, akin to DIEP flaps.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional free TRAM flaps yielded the largest abdominal donor-site morbidity and have largely fallen out of favor for DIEP flaps, which are less likely to create hernias and bulging given increased preservation of the rectus abdominus. [28][29][30] With inclusion of mesh for donor-site repair, Wan et al 30 showed a reduction in hernia and bulge rates for free and muscle-sparing TRAM flaps to approximately 4%, akin to DIEP flaps. Even 4% is significant and has driven some surgeons to use mesh for extra support with DIEP flaps, 31,32 which has ultimately become common practice at our institution as well.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Microvascular Autologous Breast Reconstruction in Patients Older Than 60 Years

et al. 2023

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Background While free-flap breast reconstruction becomes more common, it is still approached with caution in older patients. Outcomes in the elderly population have not been well characterized, especially with regard to donor-site sequalae. This study compares microvascular autologous breast reconstruction outcomes in patients older and younger 60 years. Methods A single-institution retrospective review was performed for microvascular autologous breast reconstruction from January 2004 through January 2021. Demographic, intraoperative, and postoperative variables, including breast flap and donor-site complications, were evaluated. Results Five hundred forty-five breast free flaps were identified, of which 478 (87.8%) were performed on patients younger than 60 years (mean, 46.2 years) and 67 (12.2%) older than 60 years (mean, 64.8 years; P = 0.000). Hyperlipidemia was significantly higher in older patients (19.4% vs 9.6%, P = 0.016). Mean operative time was 46.3 minutes faster in the older cohort (P = 0.030). There were no significant differences in free-flap loss, venous congestion, takeback, hematoma, seroma, wound healing, or infection. Interestingly, there were significantly more total breast flap complications (28.5% vs 16.4%, P = 0.038) and higher rates of fat necrosis (9.6% vs 1.5%, P = 0.026) in the younger cohort. Significantly more abdominal donor-site complications (43.3% vs 21.3%, P = 0.000) were seen in the older people, with increased wound breakdown (P = 0.000) and any return to the operating room (20.9% vs 9.8%, P = 0.007). Older patients were also significantly more likely to require surgical correction of an abdominal bulge or hernia (10.4% vs 4%, P = 0.020). The mean follow-up was 1.8 years. Conclusions Our data showed no worsening of individual breast flap outcomes in the older people. However, there were significantly more abdominal complications including surgical correction of abdominal bulge and hernia. This may be related to the inherent qualities of tissue aging and should be taken into consideration for flap selection. These results support autologous breast reconstruction in patients older than 60 years, but patients should be counseled regarding potentially increased abdominal donor-site sequelae.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Microvascular Autologous Breast Reconstruction in Patients Older Than 60 Years

et al. 2023

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“…[5][6][7][8][9]11,13,14,30,33,36,41,[43][44][45][46][47][48][49][50][51][52][54][55][56][57][58][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] However, the occurrence of infection in DIEP flaps is infrequent, with a recent meta-analysis reporting a donor site infection rate of 4.79%. 77 Mechanistically, ciNPWT acts as a barrier that prevents contamination of the surgical site with bacteria before reepithelization, encourages drainage of excess interstitial fluid, increases lymphatic flow, improves blood flow, and induces angiogenesis, theoretically decreasing the risk of infection and expediting healing. 78 In addition, wound dehiscence and infection often occur together and are often reported alone even when they are both present.…”

Section: Discussionmentioning

confidence: 99%

Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

Dunson,

Kogan,

Grosser

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Closed-incision negative pressure wound therapy (ciNPWT) has shown promise in reducing surgical wound complications. Among its numerous benefits, it allows for exudate management and tension offloading from wound edges. The purpose of this systematic review and meta-analysis was to assess the efficacy of prophylactic ciNPWT versus conventional dressings on abdominal donor site complications in microsurgical breast reconstruction (MR). Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in January 2023. PubMed and Embase were searched to identify all relevant studies. Data collected included rates of total wound complications, wound dehiscence, infection, seroma, and length of hospital stay. Results: A total of 202 articles were screened, and eight studies (1009 patients) met the inclusion criteria. Use of ciNPWT was associated with a significantly lower rate of wound dehiscence (OR, 0.53; 95% confidence interval, 0.33–0.85; P = 0.0085, I 2 = 0%). There was no significant difference in the rate of total wound complications [odds ratio (OR), 0.63; 95% CI, 0.35–1.14; P = 0.12, I 2 = 69%], donor site infection (OR, 0.91; 95% CI, 0.42–1.50; P = 0.47, I 2 = 13%), seroma (OR, 0.74; 95% CI, 0.22–2.49; P = 0.63, I 2 = 57%), or length of hospital stay (SMD, 0.089; 95% CI, –0.13–0.35; P = 0.37, I 2 = 29%). Conclusions: Although exudate management by ciNPWT fails to reduce surgical site infection, seroma formation, and overall length of stay, ciNPWT tension offloading properties seem to be associated with lower rates of wound dehiscence when compared with conventional dressings in abdominal-based autologous breast reconstruction.

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“…5,6 Several studies have provided evidence to support this theory, demonstrating a lower incidence of postoperative donor site complications in DIEP flap reconstruction compared with more traditional methods of autologous tissue transfer, such as TRAM flap variations. [7][8][9][10][11] Despite this lower incidence, the development of hernia and bulge following DIEP flap reconstruction is still a common occurrence, reported in more than 7% and 33% of patients who undergo this procedure. 12 Optimal techniques for abdominal fascial closure that minimize the incidence of local complications are a subject of controversy and practice variation in the plastic surgery community.…”

Section: Introductionmentioning

confidence: 99%

Initial Experience with Unidirectional Barbed Suture for Abdominal Donor Site Closure in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Finkelstein,

Ali,

Holton

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: The deep inferior epigastric perforator (DIEP) flap is a predominant technique for autologous breast reconstruction. However, the best method of abdominal fascial closure in this technique is not well defined. This study details our initial experience with unidirectional barbed suture–only repair of abdominal donor site fascia. Methods: Patients who underwent DIEP flap breast reconstruction and abdominal fascial closure with Stratafix Symmetric Polydioxanone PDS Plus were retrospectively reviewed. Information regarding pertinent patient history, medical comorbidities, risk factors, and surgical technique was extracted, along with the incidence of eight separate postoperative abdominal surgical site occurrences. Results: Retrospective review identified 43 patients who underwent 19 unilateral and 24 bilateral DIEP flap breast reconstruction procedures (n = 67). Average patient follow-up was 791 days (range 153–1769). Six patients (14%) had a complication of the donor site. Seroma was most frequent (n = 3, 7%), followed by surgical site infection (n = 2, 5%). One patient had incisional dehiscence (2%) and another patient developed bulging (2%). No patients had chronic pain, weakness, hematoma, or hernia postoperatively. Patients with donor site complications had a history of abdominal/pelvic surgery significantly more often than the patients without donor site complications (100% versus 49%; P = 0.032). Conclusions: Abdominal fascial repair with Stratafix Symmetric suture alone led to low rates of abdominal donor site morbidity, including no hernia and rare bulging, following DIEP flap breast reconstruction. Additional advantages of this technique may be reduced operative times and lower operative costs compared with alternative methods of fascial repair, although prospective and randomized studies are warranted.

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Morbidity of the Donor Site and Complication Rates of Breast Reconstruction with Autologous Abdominal Flaps: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 58 publications

Evaluation of Microvascular Autologous Breast Reconstruction in Patients Older Than 60 Years

Evaluation of Microvascular Autologous Breast Reconstruction in Patients Older Than 60 Years

Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

Initial Experience with Unidirectional Barbed Suture for Abdominal Donor Site Closure in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

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