Three-year evaluation of late breast reconstruction with a free transverse rectus abdominis musculocutaneous flap in a county hospital in Sweden: A retrospective study

Abstract

We present our three-year experience of late breast reconstruction with conventional free TRAM flaps in 16 consecutive patients in a Swedish county hospital. The breast reconstruction was done unilaterally in 14 and bilaterally in two, giving a total of 18 free TRAM flaps in 16 patients. Six patients developed anastomotic or systemic thromboembolic events during or after the operation' three developed during the operation, and one required reoperation for postoperative thrombosis. No flaps were lost. Three patients developed deep venous thrombosis (DVT) or pulmonary embolism (PE) postoperatively; the two patients with DVT were later found to be resistant to activated protein C. The patient with a PE had developed multiple metastases by one year postoperatively. We compared the six patients who developed anastomotic and systemic thromboembolic events with those whose operations were uncomplicated and no significant differences were found either in their characteristics or overall events during operation.

Free Tissue Transfer in the Private Practice Setting: A Review of 100 Patients

“…7,16,[25][26][27] There have been several reports of the use of free tissue transfer in the community hospital setting, generally involving a small number of surgeons with the assistance of residents. 6,[28][29][30] Maffi reported an 85% success rate with 53 free flaps in 49 patients by a team consisting of one attending with a plastic surgery resident and a general surgery resident in a county hospital. 6 Olsson reported 18 free TRAM flaps in 16 patients with no flap losses.…”

“…6 Olsson reported 18 free TRAM flaps in 16 patients with no flap losses. 29 The procedures were apparently performed by a team of surgeons. Elliott described a series of 111 free TRAM flaps in 100 patients in a private practice setting without flap loss.…”

“…30 The procedures were performed by the senior author with a surgical assistant or a fellow. 5,6,8,10,11,[14][15][16][17][18][19][20][21][22][23][24]28,29,32,33,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Literature ( Gusenoff reported on a comparison of 349 free tissue transfers performed in six community hospitals with 386 transfers performed in a university hospital. 28 In three of six community hospitals, there was resident coverage and apparently in the rest, the surgeon was assisted by another plastic surgeon who did not initially perform these procedures.…”

The Efficacy of Prophylactic Low-Molecular-Weight Heparin to Prevent Pulmonary Thromboembolism in Immediate Breast Reconstruction Using the TRAM Flap

“…The incidence has been reported to vary from 0.7 to 18.8 percent. 10,11 In a prospective assessment of the incidence of pulmonary thromboembolism in patients undergoing immediate TRAM flap breast reconstruction without medical prophylaxis, we observed an overall incidence of 1.3 percent, and the incidence was raised to 3.8 percent in obese patients. 12 We also found that the incidence of symptomatic or asymptomatic pulmonary thromboembolism in immediate TRAM flap breast reconstruction patients was 20.4 percent.…”

Estudo comparativo entre protocolos para profilaxia da trombose venosa profunda: uma nova proposta

“…Segundo dados da literatura, a incidência de TVP no lifting facial é 0,35% 1 , na lipoaspiração é 0,6% 2 , em abdominoplastias é cerca de 1,3% 3,4 (abdominoplastia circunferencial e a associada a cirurgia intra-abdominal apresentam incidência de TVP, respectivamente, de 3,4 e 2,17%) 5 e no retalho transverso do músculo reto abdominal (TRAM) monopediculado é 1,3% 6 . Em relação à EP, a incidência também não é definida: no lifting facial é estimada em 0,14% 1 , em abdominoplastias, 0,8% 3 (se associado a outras cirurgias, varia de 1,1% 7 a 6,6% 8 ), na lipoaspiração, 1,1% 2 , e no retalho TRAM varia de 0,7 a 18,8% 9,10 .…”