Kerilyn N Godbe, Erin Rauber, Niaman Nazir, Julie Holding, James A Butterworth, Eric C Lai, Katie G Egan
{"title":"Intraoperative Complications as Predictors of Flap Failure in Autologous Breast Reconstruction.","authors":"Kerilyn N Godbe, Erin Rauber, Niaman Nazir, Julie Holding, James A Butterworth, Eric C Lai, Katie G Egan","doi":"10.1055/a-2434-4661","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong> Intraoperative microvascular complications in autologous breast reconstruction significantly increase the risk of postoperative complications. No study has identified which specific intraoperative complications contribute to partial or total flap loss.</p><p><strong>Methods: </strong> A retrospective chart review of microsurgical breast reconstructions by five surgeons between 2009 and 2020 analyzed operative variables and patient outcomes, with complications determined from the operative report. Flap loss rates were compared between cases with and without intraoperative complications. Statistical analysis was performed using Fisher's exact and <i>t</i>-tests for discrete and continuous variables, respectively.</p><p><strong>Results: </strong> Intraoperative complications were analyzed for 1,465 autologous breast flaps performed in 916 patients. Early partial flap loss was predicted by arterial anastomosis revision (2.90 vs. 0.44%, <i>p</i> = 0.03) and alternate venous outflow (14.29 vs. 0.41%, <i>p</i> = 0.002), with no association with intraoperative thrombosis, venous revision, or difficult recipient or flap dissection. In comparison, early total flap loss was predicted by intraoperative arterial revision (5.80 vs. 0.51%, <i>p</i> = 0.001), venous revision (5.45 vs. 0.57%, <i>p</i> = 0.007), intraoperative thrombosis (12.12 vs. 0.49%, <i>p</i> < 0.001), and difficult flap dissection (2.91 vs. 0.59%, <i>p</i> = 0.04). Difficult flap dissection was the only intraoperative variable associated with late partial flap loss (6.80 vs. 1.69%, <i>p</i> = 0.004). Late total flap loss only occurred in 6/1,465 flaps, the sole association being difficult recipient vessel dissection (2.78 vs. 0.29%, <i>p</i> = 0.03). Postoperative arterial and venous compromise occurred in 1.10% (13/1,187) and 2.53% (30/1,187) of cases with no intraoperative complications, respectively, compared with 3.2% (9/278, <i>p</i> = 0.02) and 6.12% (17/278, <i>p</i> = 0.002) in cases with an intraoperative complication.</p><p><strong>Conclusion: </strong> Alternate venous outflow predicts early partial flap loss, while intraoperative thrombosis and arterial and venous revision predict early total loss. Difficult flap dissection was associated with early total and late partial flap loss, while difficult recipient vessel dissection was associated with late total flap loss.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of reconstructive microsurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2434-4661","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Intraoperative microvascular complications in autologous breast reconstruction significantly increase the risk of postoperative complications. No study has identified which specific intraoperative complications contribute to partial or total flap loss.
Methods: A retrospective chart review of microsurgical breast reconstructions by five surgeons between 2009 and 2020 analyzed operative variables and patient outcomes, with complications determined from the operative report. Flap loss rates were compared between cases with and without intraoperative complications. Statistical analysis was performed using Fisher's exact and t-tests for discrete and continuous variables, respectively.
Results: Intraoperative complications were analyzed for 1,465 autologous breast flaps performed in 916 patients. Early partial flap loss was predicted by arterial anastomosis revision (2.90 vs. 0.44%, p = 0.03) and alternate venous outflow (14.29 vs. 0.41%, p = 0.002), with no association with intraoperative thrombosis, venous revision, or difficult recipient or flap dissection. In comparison, early total flap loss was predicted by intraoperative arterial revision (5.80 vs. 0.51%, p = 0.001), venous revision (5.45 vs. 0.57%, p = 0.007), intraoperative thrombosis (12.12 vs. 0.49%, p < 0.001), and difficult flap dissection (2.91 vs. 0.59%, p = 0.04). Difficult flap dissection was the only intraoperative variable associated with late partial flap loss (6.80 vs. 1.69%, p = 0.004). Late total flap loss only occurred in 6/1,465 flaps, the sole association being difficult recipient vessel dissection (2.78 vs. 0.29%, p = 0.03). Postoperative arterial and venous compromise occurred in 1.10% (13/1,187) and 2.53% (30/1,187) of cases with no intraoperative complications, respectively, compared with 3.2% (9/278, p = 0.02) and 6.12% (17/278, p = 0.002) in cases with an intraoperative complication.
Conclusion: Alternate venous outflow predicts early partial flap loss, while intraoperative thrombosis and arterial and venous revision predict early total loss. Difficult flap dissection was associated with early total and late partial flap loss, while difficult recipient vessel dissection was associated with late total flap loss.
背景:自体乳房再造术中的术中微血管并发症大大增加了术后并发症的风险。目前还没有研究确定哪些特定的术中并发症会导致皮瓣部分或全部脱落:方法:对五位外科医生在 2009-2020 年间进行的显微外科乳房重建手术进行了回顾性病历审查,分析了手术变量和患者预后,并根据手术报告确定了并发症。比较了有术中并发症和无术中并发症病例的皮瓣缺失率。对离散变量和连续变量分别采用费舍尔精确检验和t检验进行统计分析:结果:对916名患者的1465个自体乳房皮瓣的术中并发症进行了分析。预示早期部分皮瓣脱落的因素是动脉吻合口翻修(2.90% vs 0.44%,p=.03)和备用静脉流出(14.29% vs 0.41%,p=.002),与术中血栓形成、静脉翻修、受体或皮瓣剥离困难无关。相比之下,术中动脉翻修(5.80% vs 0.51%,p=.001)、静脉翻修(5.45% vs 0.57%,p=.007)、术中血栓形成(12.12% vs 0.49%,p=.002)可预测早期皮瓣全损:交替静脉流出预示着皮瓣早期部分脱落,而术中血栓形成、动静脉翻修预示着皮瓣早期全部脱落。困难的皮瓣剥离与早期全部和晚期部分皮瓣脱落有关,而困难的受体血管剥离与晚期全部皮瓣脱落有关。
期刊介绍:
The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers.
The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases.
The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.