Comparison of Phasix, polypropylene, and primary closure of the abdominal donor site after bilateral free flap breast reconstruction: Long‐term evaluation of abdominal hernia and bulge formation

Abstract

BackgroundAbdominal free flap harvest for breast reconstruction may result in significant morbidity in terms of hernias and bulges. Reinforcement of the donor site with mesh has been recommended to minimize the risk of hernias and bulges, but no studies exist evaluating the optimal type of mesh. Polypropylene has traditionally been used but the development of Phasix restorable mesh may be a reasonable alternative. Here, we compared the use of Phasix to polypropylene and primary closure and hypothesize that the former has lower rates of abdominal morbidity in the long term.Patients and MethodsA retrospective review of all patients undergoing bilateral free flap breast reconstruction from the abdomen was performed while patients with pedicle flaps or alternative donor sites were excluded. Patient demographics, medical/surgical history, cancer treatments, and flap type were analyzed. All patients were monitored for a minimum of 2 years for early donor site complications as well as hernia/bulges.ResultsSixty‐six consecutive patients were included (40 patients with Phasix, 20 patients with polypropylene, and 6 patients with primary closure). Use of Phasix mesh resulted in higher initial operative costs ($2,750 vs. $72 vs. $0). Two patients with polypropylene mesh and one patient undergoing primary closure developed an abdominal bulge in an average follow‐up of 25.2 months (11.5% vs. 0%, p = .04).ConclusionsMesh placement for abdominal wall reinforcement after bilateral free flap breast reconstruction minimizes the risk of hernias and bulges. Although Phasix results in increased initial costs, abdominal morbidity is significantly decreased after follow‐up beyond 2 years.

Fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for soft tissue repair and reconstruction: A scoping review

“…The majority of the identified publications ( n = 50/79; 63%) involved clinical studies describing the use of P4HB mesh in plastic and reconstructive surgery ( n = 10) ( 13 – 15 , 18 – 21 , 56 , 61 , 64 ) or general surgery applications ( n = 40) ( 11 , 12 , 27 – 31 , 50 – 55 , 57 – 60 , 62 , 63 , 65 – 85 ) as shown in Figure 2 , and Table 1 . In the area of plastic and reconstructive surgery, P4HB meshes have been utilized primarily in cosmetic breast applications ( 21 ) including mastopexy/reduction mammaplasty ( 18 , 19 ), prevention of bulge at the donor site on the abdominal wall ( 14 , 64 ), support of the lower pole ( 13 , 20 , 56 ), tissue expander-based reconstruction ( 15 ), and 3-D mesh breast reconstruction with autologous fat grafting ( 61 ).…”

Evaluating mesh use for abdominal donor site closure after deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta‐analysis

“…There were 26 studies that met initial screening criteria for DIEP flap surgery with outcomes of hernia and/or bulge. After full-text review, 11 papers met our selection criteria and were ultimately included in our analysis (Butler et al, 2018;Chang et al, 2013;Haddock et al, 2021;Hsieh et al, 2009;Jakeman et al, 2022;Kraft et al, 2021;Rhemtulla et al, 2021;Siegwart et al, 2021;Wan et al, 2010;Wormer et al, 2017;Yu et al, 2020) (Figure 1). All 11 studies were retrospective cohort studies, with one of these studies prospectively inviting patients for an additional followup after identification.…”

Two-Year Preclinical Evaluation of Long-Term Absorbable Poly-4-hydroxybutyrate Scaffold for Surgical Correction of Pelvic Organ Prolapse

“…Phasix (P4HB) mesh turned out to be cost-effective in hernia repair in the long term compared with PP. Even though P4HB was associated with increased initial costs, abdominal morbidity is significantly decreased after follow-up beyond 2 years [ 38 ]. When available, cost-effectiveness analyses of P4HB scaffold should be conducted in clinical studies on POP with short- and long-term follow-up.…”