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Exposure and Closure: Addressing the Abdominal Donor Site in Autologous Breast Reconstruction
Shawn Loder MD, Vu Nguyen MD
University of Pittsburgh
2019-02-14
Presenter: Shawn J Loder
Affidavit:
This work in its entirety represents the original work of the resident under guidance of the named faculty mentor.
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Autologous tissue transfer is a powerful technique in the reconstructive surgeon's armamentarium, however, donor site complications can substantially affect both quality of life and perception of repair. Despite active study, rates of donor site comorbidities have not improved substantially over time. Here we have chosen to assess modifiable surgical factors influencing donor site complications.
Methods: This is a restrospective analysis of 282 patients undergoing free flap breast reconstruction. We assessed the relationship between flap, closure, suture characteristics and abdominal complications. Closures were divided as primary (n=246), mesh only (n=24), and unilateral (n=7) or bilateral component separation (n=3). Suture selection was assessed at the level of fascia, dermis, and skin. Complications were grouped as follows: wall (bulges, hernias), infection, fluid collection), wound dehiscence, and cumulative. All characteristics were assessed for their contribution to frequency of and time to complication.
Results: Mesh closure had higher rates of total and infectious complications vs. primary repair. Mesh closures increased the time to first wall complication without altering frequency of complications. Unilateral component separation demonstrated decreased complications vs. mesh closure. Use of V-Loc 180 suture for fascial closure shortened time to wall complications vs. Surgilon. Use of Polysorb for dermal closure demonstrated significantly higher frequency of wound complications vs. Vicryl.
Conclusion: These analyses suggests utilization of a non-mesh related closure (primary, unilateral component) reduces cumulative abdominal complications vs. mesh-based technique. Similarly, in patients who undergo primary closure, careful suture selection remains a critical determinant of the frequency and time-course of abdominal complications after harvest.
