Venous coupler size in autologous breast reconstruction—does it matter?

Broer, P. Niclas; Weichman, Katie E.; Tanna, Neil; Wilson, Stelios; Ng, Reuben; Ahn, Christina Y.; Choi, Mihye; Karp, Nolan S.; Levine, Jamie P.; Allen, Robert J.

doi:10.1002/micr.22169

Cited by 38 publications

(18 citation statements)

References 19 publications

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“…Broer et al have shown that a coupler size of less than or equal to 2.0 mm is more likely to result in venous insufficiency (6.7%) compared with the 2.5 mm (2.3%) and 3.0 mm (1.1%) sizes. 26 In this study, we did not observe venous insufficiency, especially with TMG flaps which required smaller coupler sizes. However, it is not possible to be completely certain that 100% of the venous anastomoses were patent because 15.2% of the flaps had double branching.…”

Section: Discussionmentioning

confidence: 46%

Venous coupler use for free‐flap breast reconstructions: Specific analyses of TMG and DIEP flaps

Bodin¹,

Brunetti²,

Dissaux³

et al. 2014

Microsurgery

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Section: Discussionmentioning

confidence: 46%

Venous coupler use for free‐flap breast reconstructions: Specific analyses of TMG and DIEP flaps

Bodin¹,

Brunetti²,

Dissaux³

et al. 2014

Microsurgery

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“…Some studies then proceeded to histopathology, computed tomography, or magnetic resonance imaging to confirm the diagnosis, often without a description of how fat necrosis is defined in these imaging modalities. 4,5,28,29 …”

Section: Resultsmentioning

confidence: 98%

Defining Fat Necrosis in Plastic Surgery

Rao

Saadeh

2014

Plastic and Reconstructive Surgery

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Based on the articles reviewed in this article, a more uniform definition needs to exist that is clearly defined in all articles that report on fat necrosis. The authors suggest defining fat necrosis as a palpable, discrete, and persistent subcutaneous firmness found postoperatively that measures at least 1 cm during physical examination. Fat necrosis can be identified and confirmed by imaging and histopathology or through intraoperative findings. The authors provide a classification system for fat necrosis that can be used by clinicians to describe fat necrosis into varying grades of severity to ultimately help guide clinical decision-making.

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“…Apart from the generally accepted risk factors such as smoking, diabetes, and obesity, some studies also identified associations between flap complications and flap characteristics (eg, perforator selection and number, number of veins and their size) or adjuvant treatment (eg, radiotherapy). 1–10 Despite missing consensus and insufficient evidence on the predictors of complications, data on potential risk factors are helpful for patient selection and preoperative planning.…”

mentioning

confidence: 99%

Predictors of Reoperations in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Unukovych

Gallego

Aineskog

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:The deep inferior epigastric perforator (DIEP) procedure is regarded a safe option for autologous breast reconstruction. Reoperations, however, may occur, and there is no consensus in the literature regarding the risk factors. The aim of this study was to identify factors associated with reoperations in DIEP procedure.Patients and Methods:A retrospective study of consecutive patients undergoing DIEP breast reconstruction 2007 to 2014 was performed and included a review of 433 medical charts. Surgical outcome was defined as any unanticipated reoperation requiring return to the operating room. Multivariate regression analysis was utilized to identify predictors of reoperation. The following factors were considered: age, body mass index, comorbidity, childbearing history, previous abdominal surgery, adjuvant therapy, reconstruction laterality and timing, flap and perforator characteristics, and number and size of veins.Results:In total, 503 free flaps were performed in 433 patients, 363 (83.8%) unilateral and 70 (16.2%) bilateral procedures. Mean age was 51 years; 15.0% were obese; 13.4% had hypertension; 2.3% had diabetes; 42.6% received tamoxifen; 58.8% had preoperative radiotherapy; 45.6% had abdominal scars. Reoperation rate was 15.9% (80/503) and included flap failure, 2.0%; partial flap loss, 1.2%; arterial thrombosis, 2.0%; venous thrombosis, 0.8%; venous congestion, 1.2%; vein kinking, 0.6%. Other complications included bleeding, 2.2%; hematoma, 3.0%; fat necrosis, 2.8%, and infection, 0.2%. Factors negatively associated with reoperation were childbearing history (odds ratio [OR]: 3.18, P = 0.001) and dual venous drainage (OR: 1.91, P = 0.016); however, only childbearing remained significant in the multivariate analyses (OR: 4.56, P = 0.023).Conclusions:The history of childbearing was found to be protective against reoperation. Number of venous anastomoses may also affect reoperation incidence, and dual venous drainage could be beneficial in nulliparous patients.

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Venous coupler size in autologous breast reconstruction—does it matter?

Abstract: Level III.

Cited by 38 publications

References 19 publications

Venous coupler use for free‐flap breast reconstructions: Specific analyses of TMG and DIEP flaps

Venous coupler use for free‐flap breast reconstructions: Specific analyses of TMG and DIEP flaps

Defining Fat Necrosis in Plastic Surgery

Predictors of Reoperations in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

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