The Effect of Prior Abdominal Surgery on Abdominally Based Free Flaps in Breast Reconstruction

Roostaeian, Jason; Yoon, Alfred P.; Sanchez, Ivan; Rahgozar, Paymon; Galanis, Charles; Herrera, Fernando; Tseng, Charles C.; Festekjian, Jaco H.; Lio, Andrew L. Da; Crisera, Christopher A.

doi:10.1097/01.prs.0000438059.52128.8c

Cited by 26 publications

(38 citation statements)

References 11 publications

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“…3 The effect of prior surgery on abdominally based, autologous breast reconstruction has been discussed previously, with case-control studies showing an increased risk of donor-site complications. [3][4][5][6] Computed tomography angiography (CTA) has been proposed to preoperatively visualize DIEP vasculature, with the potential to reduce intraoperative error, optimize perforator choice and dissection, and thus decrease complication rates. 7 In patients with abdominal scars, relevant operative reports are often unavailable or insufficient to determine the adequacy of DIEP perforators, making CTA a welcome adjunct for preoperative assessment.…”

mentioning

confidence: 99%

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Daly

Doval

Lin

et al. 2020

J Reconstr Microsurg

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Background This study examines the effect of prior abdominal surgery on flap, donor-site, and overall complications in women undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction and assesses whether preoperative computed tomography angiography (CTA) affects outcomes. Methods All DIEP flaps performed at our institution between 2004 and 2015 were identified retrospectively. Patients were stratified based on a history of prior abdominal surgery and whether or not they underwent a preoperative CTA. A subgroup analysis was performed to compare operative times and incidence of complications using adjusted odds ratios (ORs). Results Over a 12-year period, 425 patients (640 flaps) had prior abdominal surgery, and 393 patients (547 flaps) had no prior abdominal surgery. Of the patients with previous abdominal surgery, 67 (15.7%) underwent preoperative CTA and 333 (78.4%) did not. Patients with prior abdominal surgery were more likely to have donor-site wound complications (OR: 1.82, 95% confidence interval [CI]: 1.15–2.87, p = 0.01), fat necrosis ≥2cm of the transferred flap (OR: 1.39, 95% CI: 1.0–1.94, p = 0.05), and were more likely to have bilateral DIEP flap reconstruction (OR: 1.61, 95% CI: 1.22–2.12, p < 0.001). Preoperative CTA did not reduce the risk of complications and did not affect operative times. Conclusion DIEP flap reconstruction can be safely performed in women with prior abdominal surgery. However, these patients should be counseled that they are at an increased risk for donor-site wound breakdown and fat necrosis of the reconstructed breast. Preoperative CTA does not reduce complication rate, overall operative time, or time needed to dissect perforators in women with abdominal scars.

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confidence: 99%

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Daly

Doval

Lin

et al. 2020

J Reconstr Microsurg

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“…11,12 Subsequently, a few retrospective studies have been performed that also showed no correlation between DIEP flap complications and abdominal scars. 13,16 A recent article by Roostaeian et al 17 note that muscle and fascia sparing DIEP/superficial inferior epigastric artery (SIEA) flaps were performed with similar frequency in those with and without abdominal scars unless the patient had undergone more than 3 previous intra-abdominal operations. This study noted similar complications rates with the exception of lower partial flap loss and increased wound healing complications in those with abdominal scars.…”

Section: Discussionmentioning

confidence: 96%

Algorithmic Approach to the Design and Harvest of Abdominal Flaps for Microvascular Breast Reconstruction in Patients With Abdominal Scars

Nykiel

Hunter

Lee

2015

Annals of Plastic Surgery

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Abdominal scars increase the risk of complications to the free flap. Unlike previous studies, patients with abdominal scars do not appear to have a statistically significant increase for donor site complications. Using the data from our study, we developed an algorithm for abdominal flap harvest in patients with abdominal scars. The algorithm emphasizes the importance of bipedicled perforator flaps and supercharging/turbocharging when blood flow is required across scars or when a large volume of tissue is needed crossing the midline. In specific cases, where perforator viability is in question because of a previous abdominal surgical procedure, we recommend the inclusion of muscle (Muscle-Sparing-transverse rectus abdominis musculocutaneous vs transverse rectus abdominis musculocutaneous).

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“…Recent studies have shown no difference in flap success, however, there was a slightly higher risk of wound healing complications at the donor site [15].…”

Section: Abdominal Based Flapsmentioning

confidence: 99%

Flap-based breast reconstructions

Bartlett

Kołacińska

Spiegel

2017

Nowotwory. Journal of Oncology

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Breast cancer reconstruction is generally broken down into two major categories: Implant based and autologous. Both can provide excellent aesthetic results in the well selected patient although the decision ultimately comes down to the patient under the guidance of a reconstructive plastic surgeon. Implant based reconstruction is beyond the scope of this text, rather we will discuss autologous based reconstructive options. Broadly classified, tissue based reconstruction can be categorized as local or free tissue transfer. The general theme is the use of excess or expendable tissue in order to reconstruct breast defects. Studies have shown women are more satisfied with autologous based reconstruction compared to implanted based [1]. In this chapter we will discuss different tissue flap options in the reconstructive plastic surgeons armamentarium, special considerations and how it relates to the oncologic breast surgeon.

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The Effect of Prior Abdominal Surgery on Abdominally Based Free Flaps in Breast Reconstruction

Abstract: Risk, III.

Cited by 26 publications

References 11 publications

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Algorithmic Approach to the Design and Harvest of Abdominal Flaps for Microvascular Breast Reconstruction in Patients With Abdominal Scars

Flap-based breast reconstructions

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