Outcomes of Take-Back Operations in Breast Reconstruction with Free Lower Abdominal Flaps

Background Microvascular complications after free-flap breast reconstructions are potentially devastating problems that can increase patient morbidity and lead to flap loss. To date, no comprehensive study has examined the rates of salvage and the methods of microvascular revision in breast reconstruction. We reviewed the treatment of microvascular complications of free-flap breast reconstruction procedures over a seven-year period.

Methods A retrospective review of all patients who underwent microvascular breast reconstruction at our institution between April 2006 and December 2013 was conducted. Based on their surgical records, all patients who required emergency re-exploration were identified, the rate of flap salvage was determined, the factors associated with flap salvage were evaluated, and the causes and methods of revision were reviewed.

Results During the review period, 605 breast reconstruction procedures with a free lower abdominal flap were performed. Seventeen of these flaps were compromised by microvascular complications, and three flaps were lost. The overall salvage rate was 82.35%. No significant differences between the salvaged group and the failed group were observed with regard to age, BMI, axillary dissection, number of anastomotic arteries and veins, recipient vessel types, or use of the superficial inferior epigastric vein in the revision operation. Successful salvage of the flap was associated with a shorter time period between recognizing the signs of flap compromise and the take-back operation.

Conclusions The salvage rate of compromised lower abdominal flaps was high enough to warrant attempting re-exploration. Immediate intervention after the onset of flap compromise signs is as important as vigilant postoperative monitoring.

Keywords

Perforator flap - Surgical flaps - Free tissue flaps - Salvage therapy - Breast

The authors thank all the professors and colleagues in the Departments of Plastic Surgery at the Asan Medical Center and the University of Ulsan College of Medicine.

Publikationsverlauf

Eingereicht: 28. Mai 2015

Angenommen: 05. Oktober 2015

Artikel online veröffentlicht:
05. Mai 2022

• References

• 1 Selber JC, Angel Soto-Miranda M, Liu J. et al. The survival curve: factors impacting the outcome of free flap take-backs. Plast Reconstr Surg 2012; 130: 105-113
• 2 Chen KT, Mardini S, Chuang DC. et al. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers. Plast Reconstr Surg 2007; 120: 187-195
• 3 Mirzabeigi MN, Wang T, Kovach SJ. et al. Free flap take-back following postoperative microvascular compromise: predicting salvage versus failure. Plast Reconstr Surg 2012; 130: 579-589
• 4 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42: 645-648
• 5 Galanis C, Nguyen P, Koh J. et al. Microvascular lifeboats: a stepwise approach to intraoperative venous congestion in DIEP flap breast reconstruction. Plast Reconstr Surg 2014; 134: 20-27
• 6 Yueh JH, Slavin SA, Adesiyun T. et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 2010; 125: 1585-1595
• 7 Chin SW, Hwang WJ, Ahn HC. Fat necrosis in reconstructed breast using free TRAM flap. J Korean Soc Plast Reconstr Surg 2003; 30: 405-412
• 8 Andrades P, Fix RJ, Danilla S. et al. Ischemic complications in pedicle, free, and muscle sparing transverse rectus abdominis myocutaneous flaps for breast reconstruction. Ann Plast Surg 2008; 60: 562-567
• 9 Wei FC, Tay SK. Principle and techniques of microvascular surgery. In: Neligan PC, Gurtner GC. Plastic surgery. 3rd ed. London: Elsevier; 2012: 587-621
• 10 Nahabedian MY, Momen B, Galdino G. et al. Breast Reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 2002; 110: 466-475
• 11 Blondeel N, Vanderstraeten GG, Monstrey SJ. et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 1997; 50: 322-330
• 12 Tran NV, Buchel EW, Convery PA. Microvascular complications of DIEP flaps. Plast Reconstr Surg 2007; 119: 1397-1405
• 13 Blondeel PN, Arnstein M, Verstraete K. et al. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 2000; 106: 1295-1299
• 14 Ali R, Bernier C, Lin YT. et al. Surgical strategies to salvage the venous compromised deep inferior epigastric perforator flap. Ann Plast Surg 2010; 65: 398-406
• 15 Sbitany H, Mirzabeigi MN, Kovach SJ. et al. Strategies for recognizing and managing intraoperative venous congestion in abdominally based autologous breast reconstruction. Plast Reconstr Surg 2012; 129: 809-815
• 16 Wechselberger G, Schoeller T, Bauer T. et al. Venous superdrainage in deep inferior epigastric perforator flap breast reconstruction. Plast Reconstr Surg 2001; 108: 162-166
• 17 Eom JS, Sun SH, Lee TJ. Selection of the recipient veins for additional anastomosis of the superficial inferior epigastric vein in breast reconstruction with free transverse rectus abdominis musculocutaneous or deep inferior epigastric artery perforator flaps. Ann Plast Surg 2011; 67: 505-509
• 18 Park YJ, Kim EK, Yun JY. et al. The influence of pfannenstiel incision scarring on deep inferior epigastric perforator. Arch Plast Surg 2014; 41: 542-547