Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps

Chen, Jonlin; Varagur, Kaamya; Xun, Helen; Wallam, Sara; Karius, Alexander; Ospino, Rafael; Ji, Jenny; Sanka, Sai Anusha; Daines, John M; Skladman, Rachel; Aliu, Oluseyi; Sacks, Justin M.

doi:10.1055/a-2003-7890

Cited by 3 publications

(1 citation statement)

References 37 publications

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“…Complications in microvascular surgery, such as intraoperative flap failure and fat necrosis, can be associated with numerous factors like inexperienced surgeons, the presence of junior residents, and longer operating times. These complications often lead to longer hospital stays and higher costs [ 132 , 162 ]. Similar issues are seen in other medical fields where microsurgery is essential, like orthopedics, where ischemic time over 2 h can lead to severe complications including amputation [ 163 ].…”

Section: Potential Impacts Of Advanced Sutureless Vascular Anastomosismentioning

confidence: 99%

Sutureless vascular anastomotic approaches and their potential impacts

Ribaudo,

He,

Madira

et al. 2024

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Section: Potential Impacts Of Advanced Sutureless Vascular Anastomosismentioning

confidence: 99%

Sutureless vascular anastomotic approaches and their potential impacts

Ribaudo,

He,

Madira

et al. 2024

Bioactive Materials

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Impact of Resident and Attending Surgeon Training Level on Free Tissue Transfer Ischemia Time and Complications

Porter,

Anderson,

Ash

et al. 2024

J Reconstr Microsurg

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Background: Microsurgical free tissue transfer has become an essential method for reconstruction of complex surgical defects, making the level of training an important factor to consider. There is little published regarding the impact of training level on microsurgical outcomes. This study investigates microsurgical free tissue transfer ischemia time and post-operative complications based on resident and attending surgeon experience level. Methods: A retrospective review of all free flaps at a single institution from 1/1/2013 to 12/31/2021 was performed. Linear regression was performed analyzing ischemia time of 497 free flaps and attending surgeon experience defined by years in practice and resident level defined as post graduate year (PGY). Logistic regression model was used to analyze complications based on attending experience and resident level. Results: The average resident PGY was 3.5 +/- 0.8; the average attending has been practicing 6.4 +/- 5.1 years. There was no statistically significant difference in ischemia time or complication rates based on resident PGY or attending surgeon experience level. Conclusion: Lower PGY residents were not found to increase ischemia time or increase complication rates. Lower attending surgeon year was not found to increase ischemia time or increase complication rates compared to surgeons who had been practicing for longer. Microsurgical free tissue transfer is considered a safe procedure in residency training and trainee involvement should be encouraged to improve resident education and enhance technical skills.

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Intraoperative Complications as Predictors of Flap Failure in Autologous Breast Reconstruction

Godbe,

Rauber,

Nazir

et al. 2024

J Reconstr Microsurg

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Background: Intraoperative microvascular complications in autologous breast reconstruction significantly increase the risk of post-operative complications. No study has identified which specific intraoperative complications contribute to partial or total flap loss. Methods: A retrospective chart review of microsurgical breast reconstructions by five surgeons between 2009-2020 analyzed operative variables and patient outcomes, with complications determined from the operative report. Flap loss rates were compared between cases with and without intraoperative complications. Statistical analysis was performed using Fischer exact and t-tests for discrete and continuous variables, respectively. Results: Intraoperative complications were analyzed for 1465 autologous breast flaps performed in 916 patients. Early partial flap loss was predicted by arterial anastomosis revision (2.90% vs 0.44%, p=.03) and alternate venous outflow (14.29% vs 0.41%, p=.002), with no association with intraoperative thrombosis, venous revision, or difficult recipient or flap dissection. In comparison, early total flap loss was predicted by intraoperative arterial revision (5.80% vs 0.51%, p=.001), venous revision (5.45% vs 0.57%, p=.007), intraoperative thrombosis (12.12% vs 0.49%, p<.001), and difficult flap dissection (2.91% vs 0.59%, p=.04). Difficult flap dissection was the only intraoperative variable associated with late partial flap loss (6.80% vs 1.69%, p=.004). Late total flap loss only occurred in 6/1465 flaps, the sole association being difficult recipient vessel dissection (2.78% vs 0.29%, p=.03). Post-operative arterial and venous compromise occurred in 1.10% (13/1187) and 2.53% (30/1187) of cases with no intraoperative complications, respectively, compared to 3.2% (9/278, p=0.02) and 6.12% (17/278, p=0.002) in cases with an intraoperative complication. Conclusions: Alternate venous outflow predicts early partial flap loss, while intraoperative thrombosis, and arterial and venous revision predict early total loss. Difficult flap dissection was associated with early total and late partial flap loss, while difficult recipient vessel dissection was associated with late total flap loss.

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Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps

Cited by 3 publications

References 37 publications

Sutureless vascular anastomotic approaches and their potential impacts

Sutureless vascular anastomotic approaches and their potential impacts

Impact of Resident and Attending Surgeon Training Level on Free Tissue Transfer Ischemia Time and Complications

Intraoperative Complications as Predictors of Flap Failure in Autologous Breast Reconstruction

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