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The Effect of Intra-Flap Irrigation with Heparinized Saline in Microvascular Autologous Breast Reconstruction
Minh Nguyen MD, Rohini Kadle MD, Angela Volk MD, Kshipra Hemal MD, Mykal Gerald MD, Vishal Thanik MD, David Nash MD
The Ohio State University Wexner Medical Center
2024-01-31
Presenter: Minh Nguyen
Affidavit:
I, Gregory Pearson, certifies that this abstract represents the resident original work.
Director Name: Gregory Pearson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Heparinized saline irrigation in microvascular breast reconstruction reduces the rate of thrombosis based on previous animal study. This study aimed to assess the effect of routine intra-flap irrigation with heparinized saline on flap outcomes in patients undergoing abdominally-based microvascular breast reconstruction.
Methods: A retrospective chart review was conducted for patients who underwent abdominally-based microvascular breast reconstruction at two institutions between 2016 and 2023. One institution in Ohio routinely performed intra-flap heparinized saline irrigation (Group 1), while the other institution in New York did not (Group 2). The analysis included patient demographics, operative and post-operative course, and complication rates. Patients with alternative donor sites were excluded due to variations in takeback rates.
Results: 200 patients with 305 flaps (Group 1 = 100 patients, 152 flaps; Group 2 = 100 patients, 153 flaps) were identified for the study. The average age was 52.1 years, with an average BMI of 29.8. The average follow-up period was 12.2 months. Group 1 had a significantly higher BMI (31.5 vs. 28.5, p<0.001). There was no difference in Immediate takeback rates for flap compromise, partial or complete flap loss. Fat necrosis was more prevalent in Group 1 (20.4% vs. 11.2%, p=0.028). Nevertheless, intra-flap irrigation with heparinized saline did not independently contribute to fat necrosis in our multivariate analysis. No significant differences were observed in other complications.
Conclusions: The routine use of heparinized saline intra-flap irrigation did not have a significant impact on flap compromise or long-term flap outcomes in microvascular breast reconstruction.
