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Comprehensive Analysis of Complications Following Abdominal Based Free Flap Breast Reconstruction at a Single Tertiary Care Institution

Eliana F R Duraes MD, Graham Schwarz MD, Paul Durand MD, Andrea Moreira MD, Joao Batista de Sousa MD PhD, Risal S Djohan, James Zins, Steven Bernard, MD
Cleveland Clinic OHIO - Department of Plastic Surgery
2014-03-15

Presenter: Eliana F R Duraes

Affidavit:
This work was a original work of the presenter research fellow.

Director Name: Steven L Bernard

Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)

Purpose: The purpose of this study was to analyze the complications following free tissue autologous breast reconstruction in a high volume tertiary institution.

Methods: A single institution database was queried to identify all patients operated for abdominal based free flap breast reconstruction, from August 2012 to December 2013. Complications were identified and possible risk factors were statistically analyzed using SPSS software.

Results: Total number of patients was 131, 61 for bilateral reconstructions. Mean surgery time was 570.5 min (±151.24). Sixty-one patients (46.6%) had early complications. Reoperations due to complications were required in 19 (14.5%) patients on the first 30 days with 7 patients requiring multiple reoperations. Nine patients required reoperations after 30 days (5 wound debridements and 4 bulge/abdominal hernia repairs). The major complications found were 2 (1.04%) total flap losses and a case of disseminated infection with loss of skin coverage of the breasts. Early complications were higher in smokers and patients who recently quit smoking, than non-smokers (p=0.007). Smoking status did not increase reoperations (p=0.105) or late complications (p=0.747). Bilateral or unilateral operation, immediate/delayed surgery, radiotherapy use, age, BMI, hypertension, diabetes, and operation time were not statistically significant for early complications, late complications or reoperations (p>0.05).

Conclusions: Abdominally based free flap breast reconstructions are complex surgeries with a delicate post-operative follow up. Nonetheless, careful planning and execution can lead to few major complications in congruence with those found on current scientific literature. In this series, smoking was found to be a significant risk factor for early complications.

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