![[ Visit Client Website ]](images/banner.gif)
Methods: Retrospective review of all free flaps performed for breast reconstruction at a single institution from 2000-2010.
Results: Overall 2138 flaps were performed in 1608 patients (unilateral: 1120 patients, bilateral: 488 patients) with 153 compromised flaps (7.2%) and 43 flap losses (2.0%). Age, BMI, smoking, pre-operative radiation and chemotherapy, timing of reconstruction, and surgeon experience did not affect flap loss. The majority of flap losses occurred following unilateral reconstruction which was significantly higher that bilateral reconstruction (28 vs. 15; p=0.04). Subgroup analysis on flap type demonstrated DIEP and other flaps (SIEA and SGAP) were at significantly higher risk for flap loss (OR 1.43; p=0.02 and 3.61; p=0.05 respectively) compared to TRAM and MS-TRAM flaps. Perforator number did not have an impact on flap loss rates. While an intraoperative complication was not associated with a flap loss, the need for a reoperation was stronger indicative of a flap loss (p<0.0001). Flap salvage was highest within the first 24 hours (83.7%) and significantly less between days 1-3 (38.6%; p<0.0001) and beyond 4 days (29.4%; p<0.0001). Ischemia time was significantly associated with flap loss with a 1% increase in flap loss rate with every minute of ischemia time (p=0.04). An arteriovenous thrombosis was significantly associated with a flap loss than an isolated arterial (n=18) or venous thrombosis (n=14) alone (p=0.009). Salvage techniques (aspirin, heparinzation, thrombectomy, and thrombolytic) had no impact on flap salvage rates.
Conclusions: Free flap loss following breast reconstruction is multi-factorial with higher losses in less frequently performed flaps such as an SIEA or gluteal flap and is also associated with longer ischemia times. Salvage rates are most successful within the first 24 hours, and the use of heparinization, aspirin, and thrombolytics do not improve salvage rates.