Risk Factors and Complications in Free TRAM Flap Breast Reconstruction

Selber, Jesse C.; Kurichi, Jibby E.; Vega, Stephen J.; Sonnad, Seema S.; Serletti, Joseph M.

doi:10.1097/01.sap.0000210180.72721.4a

Cited by 146 publications

(94 citation statements)

References 22 publications

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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%

“…Complications after breast reconstructive surgery are common (1)(2)(3)(4)(5)(6), and it has been shown that complications affect patient emotional well-Identifying independent risk factors for complications could have multiple advantages, such as making the treatment of patients with breast cancer requesting reconstruction more effective and aiding in selection of the best reconstruction method for each patient.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: The Effect Of Patient Characteristics On Breast Reconstructionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…A purely technical reason for a failure may be too overly simplified. The evidence for this is provided by recent papers by Serletti [27][28]. A high-volume experienced surgeon with an enviably low 0.29% rate of failure in performing DIEP or free TRAM flaps has a 10x fold increase in failure to 2.9% when doing SIEA flaps [29].…”

Section: Discussionmentioning

confidence: 99%

“…A culture of success is reflected in their failure rates which are historically low [8][9][10][11][12]17,28,31]. It's important to mention that when a variety of flaps or new flaps are used the success rate goes down with a thrombotic rate of 17.4%, even at centers of excellence [28].…”

Section: Discussionmentioning

confidence: 99%

Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon's inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon's practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.

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“…Continued tobacco use after a cancer diagnosis has been associated with various detrimental clinical outcomes such as shorter survival (Videtic et al, 2003;Fox et al, 2004;Sardari Nia et al, 2005;Zhou et al, 2006;Nguyenet al, 2010;Parsonset al, 2010;Kenfield, et al, 2011); increased risk of tumor recurrence or development of secondary malignancies (Do et al, 2003;Kawaguchi et al, 2006;Garces et al, 2007;Kaufman et al, 2008;Li et al, 2009;Joshu et al, 2011); poorer response to treatment and an increased risk of treatment toxicities (Monson et al, 1998;Dresler, 2003;O'Sullivan et al, 2003;van der Bol et al, 2007;de Jong et al, 2008;Waller et al, 2011;Petros et al, 2012); an increased risk of surgical complications (Moller et al, 2002;Barrera et al, 2005;Selber et al, 2006;Liu et al, 2011); and inferior bone marrow transplantation outcomes (Marks et al, 2009;Ehlers et al, 2011 ;Tran et al, 2011). Conversely, smoking cessation post-cancer diagnosis has been associated with better pain control and an improved quality of life (Garces et al, 2004;Baser et al, 2006;Daniel et al, 2009;Ditre et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Smoking Cessation Treatment and Outcomes in Medium to Heavy Cigarette Smokers being Treated for Cancer in Jordan

Hawari¹,

Obeidat²,

Ayub³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Studies evaluating smoking cessation treatment outcomes in cancer patients are scarce, despite smoking cessation importance in cancer care. We sought to add to the literature by evaluating smoking cessation in a challenging group of cancer patients (medium-to-heavy smokers) visiting an out-patient smoking cessation clinic (SCC) in a cancer center in Amman, Jordan. Materials and Methods: Patients smoking >9 cigarettes per day (CPD) and referred to the SCC between June 2009 and May 2012 were studied. Clinic records were reviewed to measure demographic and baseline clinical characteristics, and longitudinal (3-, 6-and 12-month) followup by phone/clinic visit was conducted. At each follow-up, patients were asked if they experienced medication side-effects, if they had returned to smoking, and reasons for failing to abstain. Descriptive and multivariable logistic regression analyses were performed. Results: A total of 201 smokers were included in the analysis. The 3-month abstinence was 23.4% and significantly associated with older age, being married, and presenting with lower (≤10ppm) baseline carbon monoxide (CO) levels. On a multivariable level, lower CO levels, a higher income (relative to the lowest income group), being older, and reporting severe dependence (relative to dependence reported as 'somewhat' or 'not') were significant predictors of higher odds of abstinence at three months. Reasons for failing to quit included not being able to handle withdrawal and seeing no value in quitting. Longterm ARs did not reach 7%. Conclusions: In a sample of Jordanian smokers (>9CPD) with cancer and receiving smoking cessation treatment, ARs were low and further declined with time. Results underscore the need for more aggressive patient management and rigorous follow-up during and after smoking cessation treatment, particularly when this takes place in challenging settings. Observed reasons for failure to abstain should be used to tailor counseling practices.

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Risk Factors and Complications in Free TRAM Flap Breast Reconstruction

Abstract: Awareness of risk factors and associated complications will lead to modification and individualization of surgical techniques in an attempt to limit these complications and continually improve outcomes.

Cited by 146 publications

References 22 publications

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

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

Anatomy of Free Flap Failures: Dissection of a Series

Smoking Cessation Treatment and Outcomes in Medium to Heavy Cigarette Smokers being Treated for Cancer in Jordan

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