A Multicentre Study of the Relationship between Abdominal Flap and Mastectomy Weights in Immediate Unilateral Free Flap Breast Reconstruction and the Effect of Adjuvant Radiotherapy

Abstract Background Accurate flap weight estimation is crucial for preoperative planning in microsurgical breast reconstruction; however, current flap weight estimation methods are time consuming. It was our objective to develop a parsimonious and accurate formula for the estimation of abdominal-based free flap weight. Methods Patients who underwent hemi-abdominal-based free tissue transfer for breast reconstruction at a single institution were retrospectively reviewed. Subcutaneous tissue thicknesses were measured on axial computed tomography angiograms at several predetermined points. Multivariable linear regression was used to generate the parsimonious flap weight estimation model. Split-sample validation was used to for internal validation. Results A total of 132 patients (196 flaps) were analyzed, with a mean body mass index of 31.2 ± 4.0 kg/m2 (range: 22.6–40.7). The mean intraoperative flap weight was 990 ± 344 g (range: 368–2,808). The full predictive model (R 2 = 0.68) estimated flap weight using the Eq. 91.3x + 36.4y + 6.2z – 1030.0, where x is subcutaneous tissue thickness (cm) 5 cm lateral to midline at the level of the anterior superior iliac spine (ASIS), y is distance (cm) between the skin overlying each ASIS, and z is patient weight (kg). Two-thirds split-sample validation was performed using 131 flaps to build a model and the remaining 65 flaps for validation. Upon validation, we observed a median percent error of 10.2% (interquartile range [IQR]: 4.5–18.5) and a median absolute error of 108.6 g (IQR: 45.9–170.7). Conclusion We developed and internally validated a simple and accurate formula for the preoperative estimation of hemi-abdominal-based free flap weight for breast reconstruction.

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Preliminary experience using the VITOM-3D system for microvascular anastomosis in DIEP free flap breast reconstruction

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2021.11.099 ◽

2021 ◽

Author(s):

R.N Manton ◽

F. Ahmed ◽

H. Ridha

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Microvascular Anastomosis

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Lower Percentage of the Patients in Breast Reconstruction After Mastectomy Group Who Received Adjuvant Radiotherapy Might Be Associated With Higher Work Ability and Productivity

Annals of Plastic Surgery ◽

10.1097/sap.0000000000001710 ◽

2019 ◽

Vol 82 (3) ◽

pp. 359

Author(s):

Kadri Altundag

Keyword(s):

Breast Reconstruction ◽

Work Ability ◽

Adjuvant Radiotherapy ◽

Lower Percentage ◽

Mastectomy Group

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Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites

Journal of Clinical Medicine ◽

10.3390/jcm10215176 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5176

Author(s):

Jennifer Wang ◽

Zyg Chapman ◽

Emma Cole ◽

Satomi Koide ◽

Eldon Mah ◽

...

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Negative Pressure ◽

Statistical Significance ◽

Future Research ◽

Wound Complications ◽

Negative Pressure Therapy ◽

Royal Melbourne Hospital ◽

Pressure Therapy ◽

The Impact

Background: Closed incision negative pressure therapy (ciNPT) may reduce the rate of wound complications and promote healing of the incisional site. We report our experience with this dressing in breast reconstruction patients with abdominal free flap donor sites. Methods: A retrospective cohort study was conducted of all patients who underwent breast reconstruction using abdominal free flaps (DIEP, MS-TRAM) at a single institution (Royal Melbourne Hospital, Victoria) between 2016 and 2021. Results: 126 female patients (mean age: 50 ± 10 years) were analysed, with 41 and 85 patients in the ciNPT (Prevena) and non-ciNPT (Comfeel) groups, respectively. There were reduced wound complications in almost all outcomes measured in the ciNPT group compared with the non-ciNPT group; however, none reached statistical significance. The ciNPT group demonstrated a lower prevalence of surgical site infections (9.8% vs. 11.8%), wound dehiscence (4.9% vs. 12.9%), wound necrosis (0% vs. 2.4%), and major complication requiring readmission (2.4% vs. 7.1%). Conclusion: The use of ciNPT for abdominal donor sites in breast reconstruction patients with risk factors for poor wound healing may reduce wound complications compared with standard adhesive dressings; however, large scale, randomised controlled trials are needed to confirm these observations. Investigation of the impact of ciNPT patients in comparison with conventional dressings, in cohorts with equivocal risk profiles, remains a focus for future research.

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