Use of Strict Patient Selection Criteria to Achieve Significant Surgical Outcomes from a Low DIEP Flap Breast Reconstruction

2019 ◽  
Vol 35 (08) ◽  
pp. 622-630
Author(s):  
Han Gyu Cha ◽  
Min Kyu Kang ◽  
Hyun Ho Han ◽  
Eun Key Kim ◽  
Jin Sup Eom
Keyword(s):  
Breast Reconstruction ◽  
Ct Angiography ◽  
Patient Selection ◽  
Surgical Outcomes ◽  
Selection Criteria ◽  
Diep Flap ◽  
Complication Rates ◽  
Abdominal Scar ◽  
Significant Difference ◽  
Patient Selection Criteria

Abstract Background The low deep inferior epigastric perforator (DIEP) flap was first introduced in 2016 as it had aesthetic advantages over the conventional DIEP flap. With our experience of over 100 low DIEP flap procedures to date, we have conspicuously lowered complication rates and established more definitive criteria to select proper candidates. Methods We analyzed 103 patients who underwent breast reconstruction with the low DIEP flap at our hospital between May 2014 and June 2018. Demographics, patient selection criteria, flap specifics, surgical outcomes including postoperative complications, and the location of the abdominal scar and umbilicus were reviewed retrospectively. Results The mean patient age was 46.7 years, and the average body mass index was 23.7 kg/m2. A low DIEP with an average weight of 377 g was utilized within 6 hours 17 minutes in this cohort. There was no significant difference in the rate of venous congestion or fat necrosis compared with the conventional DIEP flap. The average distance from the pubic hairline to the abdominal scar was 0.6 cm and from the anterior superior iliac spine to the abdominal scar was −0.4 cm. The postoperative location of the umbilicus was 7.0 cm above the pubic hairline. Conclusion The low DIEP flap is not only a reliable option for a breast reconstruction but is an aesthetically superior approach with a lower abdominal scar and natural umbilicus. Patients may benefit from this technique if prudently selected by computed tomography (CT) angiography. A perforator that is larger than 1 mm in diameter and well enhanced on CT angiography from the division of the external iliac artery to the abdominal skin particularly in the intramuscular course should be selected.

PATIENT SELECTION CRITERIA IN THE SURGICAL TREATMENT OF VENO-OCCLUSIVE DYSFUNCTION

1999 ◽  
Vol 161 (4) ◽  
pp. 1145-1147 ◽  
Author(s):  
F. SASSO ◽  
G. GULINO ◽  
J. WEIR ◽  
A.M. VIGGIANO ◽  
E. ALCINI
Keyword(s):  
Surgical Treatment ◽  
Patient Selection ◽  
Selection Criteria ◽  
Patient Selection Criteria

scholarly journals Suggested Patient Selection Criteria for Initial Clinical Trials of Pig Kidney Xenotransplantation in the USA

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Abhijit Jagdale ◽  
Vineeta Kumar ◽  
Douglas J. Anderson ◽  
Jayme E. Locke ◽  
Michael J. Hanaway ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Patient Selection ◽  
Selection Criteria ◽  
Pig Kidney ◽  
The Usa ◽  
Patient Selection Criteria

Postoperative Free Flap Breast Protocol Optimizing Resources and Patient Safety

2020 ◽  
Vol 36 (05) ◽  
pp. 379-385 ◽  
Author(s):  
Darya Fadavi ◽  
Allison Haley ◽  
Nima Khavanin ◽  
Franca Kraenzlin ◽  
Tobias J. Bos ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Hospital Discharge ◽  
Failure Rate ◽  
Cost Savings ◽  
Reoperation Rate ◽  
Hospital Length Of Stay ◽  
Diep Flap ◽  
Complication Rates ◽  
Icu Admission ◽  
Flap Failure

Abstract Background As deep inferior epigastric artery perforator (DIEP) flaps have gained popularity in breast reconstruction, the postoperative care of these patients, including the appropriate hospital length-of-stay and the need for intensive care unit (ICU) admission, has become a topic of debate. At our institution, we have adopted a pathway that aims for discharge on postoperative day 3, utilizing continuous tissue oximetry without ICU admission. This study aims to evaluate outcomes with this pathway to assess its safety and feasibility in clinical practice. Methods A retrospective review was performed of patients undergoing DIEP flap breast reconstruction between January 2013 and August 2014. Data of interest included patient demographics and medical history as well as complication rates and date of hospital discharge. Results In total, 153 patients were identified undergoing 239 DIEP flaps. The mean age was 50 years (standard deviation [SD] = 10.2) and body mass index (BMI) 29.4 kg/m2 (SD = 5.2). Over the study period, the flap failure rate was 1.3% and reoperation rate 3.9%. Seventy-one percent of patients were discharged on postoperative day 3. Nine patients required hospitalization beyond 5 days. Theoretical cost savings from avoiding ICU admissions were $1,053 per patient. Conclusion A pathway aiming for hospital discharge on postoperative day 3 without ICU admission following DIEP flap breast reconstruction can be feasibly implemented with an acceptable reoperation and flap failure rate.

scholarly journals Prepectoral Direct-to-Implant Breast Reconstruction: Early Outcomes and Analysis of Postoperative Pain

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Rafi Fredman ◽  
Cindy Wu ◽  
Mihaela Rapolti ◽  
Daniel Luckett ◽  
Jason Fine ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Breast Reconstruction ◽  
Statistical Significance ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Trade Offs ◽  
Technological Advances ◽  
Significant Difference ◽  
Aesthetic Results ◽  
Postmastectomy Radiation Therapy

Abstract Background Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results in appropriate candidates. Most commonly, implants are placed in the subpectoral space which can lead to pain and breast animation. Surgical and technological advances have allowed for successful prepectoral implant placement which may eliminate these trade-offs. Objectives Here we present early outcomes from 153 reconstructions in 94 patients who underwent prepectoral DTI. We sought to determine whether these patients have less postoperative pain and narcotic use than subpectoral implant or expander placement. Methods A retrospective review was performed for all prepectoral DTI reconstructions at our institution from 2015 to 2016. Data were collected on postoperative pain and narcotic use while in hospital. Results The average follow-up time was 8.5 months (range, 3–17 months) and the overall complication rate was 27% (n = 41) with the most common complications being skin necrosis (9%, n = 13) and infection (7%, n = 11). No statistically significant difference in complications was found in patients who underwent postmastectomy radiation therapy. Patients who underwent prepectoral DTI reconstruction did not have a statistically significant difference in postoperative pain and narcotic use while in-hospital compared with other techniques. Conclusion Prepectoral DTI reconstruction provides good results with similar complication rates to subpectoral techniques. Prepectoral DTI eliminates the problem of breast animation. Although our series did not reach statistical significance in pain scores or requirement for postoperative narcotics, we believe that it is an important preliminary result and with larger numbers we anticipate a more definitive conclusion. Level of Evidence: 4

scholarly journals Analysis of deaths in patients awaiting heart transplantation: impact on patient selection criteria.

Heart ◽  
1996 ◽  
Vol 75 (5) ◽  
pp. 455-462 ◽  
Author(s):  
G. A. Haywood ◽  
P. R. Rickenbacher ◽  
P. T. Trindade ◽  
L. Gullestad ◽  
J. P. Jiang ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Patient Selection ◽  
Selection Criteria ◽  
Patient Selection Criteria

scholarly journals Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

2021 ◽  
Vol 10 (5) ◽  
pp. 1016
Author(s):  
Paul I. Heidekrueger ◽  
Nicholas Moellhoff ◽  
Raymund E. Horch ◽  
Jörn A. Lohmeyer ◽  
Mario Marx ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
National Level ◽  
Length Of Hospital Stay ◽  
High Standard ◽  
High Volume ◽  
National Registry ◽  
Wound Complications ◽  
Diep Flap ◽  
Complication Rates

While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.

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