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A Systematic Approach to Emergent Breast Free Flap Takeback: The FIGHTR Algorithm
Ibrahim Khansa, MD;
Maakan Taghizadeh, MD;
Theodore Nagel, MD;
Duane Wang, BS;
Pankaj Tiwari, MD
The Ohio State University Wexner Medical Center
2013-02-28
Presenter: Ibrahim Khansa, MD
Affidavit:
The material presented in this abstract is Dr. Khansa's original work, and has not been previously published in any journal or presented at any meeting.
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: The purposes of this study are to analyze our outcomes with attempted breast free flap salvage after intraoperative and postoperative vascular compromise, to review the existing literature on various salvage modalities, and to present our algorithm for free flap salvage.
Methods: A retrospective chart review was performed on all breast free flaps performed at our institution between May 2007 and December 2012. Flaps with intraoperative and postoperative vascular complications were analyzed. The various modalities used in the salvage attempt were reviewed, and the rate of total flap loss was measured. Other complications, including hematoma, were also recorded.
Results: 612 microsurgical breast reconstructions in 442 patients were reviewed. There were 72 flaps with intraoperative vascular complications, and 36 flaps that underwent reexploration for postoperative vascular complications. Postoperative arterial compromise had a significantly lower rate of successful salvage than intraoperative arterial compromise (62.5% vs. 89.8%, p=0.01). A similar but nonsignificant trend was observed with venous compromise (78.3% vs. 96%, p=0.06). The most commonly used modalities in free flap salvage were anastomotic revision and heparin irrigation, followed by systemic heparin, Fogarty catheter thrombectomy, thrombolytics and indocyanine green angiography.
Conclusions: Postoperative arterial compromise has a significantly worse prognosis than intraoperative arterial compromise. Prompt return to the operating room for reexploration is essential to salvage success. Our rigorous and systematic approach to flap monitoring and salvage ensures that all necessary equipment is available before the patient arrives in the operating room. Our salvage rates after postoperative vascular compromise compare favorably to the published literature.
