Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions—A Comparison of Two Reconstructive Centers with and without ERAS-Protocol

Linder, Sora; Walle, Leonard; Loucas, Marios; Loucas, Rafael; Frerichs, O.; Fansa, Hisham

doi:10.3390/jpm12030347

Cited by 16 publications

(12 citation statements)

References 22 publications

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“…In this study, LOS was similar at both institutions (5.5±1 days at PC and 5.5±0.9 days at CH, mean ± SD). While LOS was longer compared with other studies, it was within the range reported by another Swiss center ( 22 - 24 ). The authors hypothesize that the difference compared with centers in other countries may be due to insurance policies or preoperative counseling and expectation setting ( 25 ).…”

Section: Discussionsupporting

confidence: 75%

Comparing complications and perioperative teams in microsurgical breast reconstruction: retrospective cohort study

Speck¹,

Dreier²,

Fluetsch³

et al. 2022

Gland Surg

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Background: Subspecialization with dedicated perioperative teams has become common practice in some surgical disciplines. While surgeon experience, the number of surgeons involved, and enhanced recovery after surgery (ERAS) pathways are known factors affecting the outcome after microsurgical breast reconstruction, the impact of the perioperative team has not been studied. Methods:We conducted a retrospective cohort study consisting of a chart review of all patients who underwent microsurgical breast reconstruction from January 2019-April 2020. Surgery was performed by three microsurgeons at two institutions with different perioperative teams-one being a small clinic [private clinic (PC), 33 beds] and the other being a larger hospital [corporate hospital (CH), 335 beds]. Patients were grouped into two cohorts according to the institution where surgery was performed. The primary outcomes studied were frequency of revision surgery, flap loss and patient length-of-stay (LOS).Results: One hundred and fifty microsurgical breast reconstructions were performed in 125 patients.Demographic data [age, body mass index (BMI), current tobacco use, donor site] was found statistically comparable between both cohorts. In the PC cohort with fewer perioperative care providers, lower rates of revision surgery and flap loss were observed (P value =0.009 and 0.04, respectively). LOS was not significantly different between the two cohorts (P value =0.44). Conclusions:The outcome of microsurgical breast reconstruction depends on multiple factors. In this study, fewer flap complications occurred at the small clinic. One reason among others might be the lower number of perioperative care providers involved and hence higher likelihood of sharing microsurgical cases, which facilitates routine and ensures less variability in care. The value of perioperative team subspecialization in microsurgical breast reconstruction needs to be assessed in prospective studies.

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Section: Discussionsupporting

confidence: 75%

Comparing complications and perioperative teams in microsurgical breast reconstruction: retrospective cohort study

Speck¹,

Dreier²,

Fluetsch³

et al. 2022

Gland Surg

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“…Our trust follows the DIEP flap Enhanced Recovery After Surgery program to shorten inpatient stay, reduce postoperative pain, and improve outcomes. 12–14…”

Section: Methodsmentioning

confidence: 99%

“…Our trust follows the DIEP flap Enhanced Recovery After Surgery program to shorten inpatient stay, reduce postoperative pain, and improve outcomes. [12][13][14] There were 67 unipedicled and 31 bipedicled DIEP flaps (bilateral unipedicled + unilateral bipedicled). Procedure type varied slightly with some reconstructions being immediately after mastectomy (N = 63) and others delayed (N = 35).…”

Section: Patientsmentioning

confidence: 99%

A Single-center Comparison of Unipedicled and Bipedicled Diep Flap Early Outcomes in 98 Patients

Ahmed

Ioannidi

Ghali

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background:The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. One or two pedicles may be used. Our study is the first to compare unipedicled and bipedicled DIEP flaps on donor and recipient site outcomes in the same patient cohort. Methods: This is a retrospective cohort study comparing DIEP flap outcomes between 2019 and 2022. Results: There were 98 patients, categorized differently for recipient or donor site. The recipient groups were unilateral unipedicled (N = 52), bilateral unipedicled (N = 15), and unilateral bipedicled (N = 31), and donor site groups were unipedicled (N = 52) and bipedicled (N = 46, including bilateral unipedicled and unilateral bipedicled). Bipedicled DIEP flaps had 1.15 times greater odds of donor site complication (95% CI, 0.52-2.55). Adjusting for operative time that was longer in bipedicled DIEP flaps (P < 0.001), odds ratio decreased, and there was a lower probability of donor site complication for bipedicled flaps (OR, 0.84; 95% CI, 0.31-2.29). Odds of recipient area complication was not significantly different between groups. Unilateral unipedicled DIEP flaps had significantly higher rates of revisional elective surgery than unilateral bipedicled DIEP flaps (40.4% versus 12.9%; P = 0.029). Conclusions:We demonstrate no significant difference in donor site morbidity between unipedicled and bipedicled DIEP flaps. Bipedicled DIEP flaps do have slightly higher rates of donor site morbidity, which can be partly explained by longer operative times. There is no significant difference in recipient site complications, and bipedicled DIEP flaps can reduce rates of further elective surgery.

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“…The deep inferior epigastric perforator flap (DIEP) has become the widely accepted gold standard for breast reconstruction. Its benefits are a low donor site morbidity and due to the tissue characteristics, a superior aesthetic result of the reconstructed breast [ 4 ]. Unlike in the pioneering days of microsurgery, autologous breast reconstruction today is not only about the survival of the flap but also about the aesthetic result of the breast and the donor site.…”

Section: Introductionmentioning

confidence: 99%

The Scarless Neo-Umbilicus in DIEP-Flap Breast Reconstruction

Linder

Fansa

2023

JPM

Self Cite

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While the DIEP (deep inferior epigastric perforator) flap has become the gold standard in autologous breast reconstruction due to its favourable tissue characteristics and preserved abdominal wall function, a constant attempt is done to improve the outcome of the donor site. Even if just a small detail, the umbilicus has a big impact on the overall aesthetic outcome of the donor site. As an already established technique in abdominoplasties, we introduced the neo-umbilicus as the standard procedure for DIEP donor site closure. The aim of this study was to assess the aesthetic outcome of this neo-umbilicoplasty technique in DIEP-flaps. This is a single-center cohort study. A total of 30 consecutive breast cancer patients were treated during a period of 9 months with a mastectomy and an immediate reconstruction with a DIEP-flap. In all patients, the reconstruction of the umbilicus was done by an immediate neo-umbilicoplasty technique, consisting of a cylindrical fat resection at the new loco typico and fixation of the dermis directly to the rectus fascia. All patients were photographed in a standardised setting. Subjective patient satisfaction was assessed with a survey consisting of three questions and aesthetic outcome was evaluated by an independent professional panel consisting of three plastic surgeons. The results were compared to a previous cohort of conventional umbilicoplasties in DIEP-flap patients. Twenty-six patients participated in the follow-up study. There were no wound complications associated with the neo-umbilicus. Questionnaire results demonstrated high but not statistically significant different patient satisfaction. The panel scores were statistically significant (p < 0.05) better for the neo-umbilicus reconstructions. The aesthetic outcome was rated higher in patients with a higher BMI compared to those in patients with a low BMI. The creation of a neo-umbilicus at the donor site after DIEP-flap breast reconstruction is a quick and safe technique and leads to a superior aesthetic donor site result.

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Enhanced Recovery after Surgery (ERAS) in DIEP-Flap Breast Reconstructions—A Comparison of Two Reconstructive Centers with and without ERAS-Protocol

Cited by 16 publications

References 22 publications

Comparing complications and perioperative teams in microsurgical breast reconstruction: retrospective cohort study

Comparing complications and perioperative teams in microsurgical breast reconstruction: retrospective cohort study

A Single-center Comparison of Unipedicled and Bipedicled Diep Flap Early Outcomes in 98 Patients

The Scarless Neo-Umbilicus in DIEP-Flap Breast Reconstruction

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