Time‐dependent factors in <scp>DIEP</scp> flap breast reconstruction

Laporta, Rosaria; Longo, Benedetto; Sorotos, Michail; Farcomeni, Alessio; Amorosi, Vittoria; Pompeo, Fabio Santanelli di

doi:10.1002/micr.30203

Cited by 28 publications

(20 citation statements)

References 29 publications

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Section: Discussionsupporting

confidence: 92%

“…Our operation time was in line with the prior study, where the mean operation time was 289 min [23]. The length of operation tended to be longer both in overweight and obese patients, which also agrees with earlier reports [14,23]. The duration of surgery has been reported to be an independent risk factor for postoperative complications [21], which was not supported by our study.…”

Section: Discussionsupporting

confidence: 90%

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Is there any difference in perioperative characteristics or postoperative complications between overweight, normal-weight and obese patients in delayed DIEP reconstructions?

Palve

Luukkaala

Kääriäinen

2021

Journal of Plastic Surgery and Hand Surgery

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Increased number of overweight and obese women are seeking breast reconstruction. Studies have demonstrated that obese experience increased rates of complications, but less data is available considering overweight patients. We analyzed the impact of body mass index (BMI) on perioperative characteristics and complications in unilateral delayed deep inferior epigastric perforator flap (DIEP) reconstructions. The records of patients with DIEP reconstruction performed between 2014 and 2020, were retrospectively analyzed. Patients were categorized into obese (BMI !30), overweight (BMI 25.0-29.9), and normal-weight groups (BMI <25). Patient characteristics (age, comorbidity, radiation, abdominal surgery, ASA category, and smoking), perioperative characteristics (length of operation, blood loss, vasoactive drugs, fluid administration, and urine output), and postoperative complications were recorded. The study included 308 patients. Of these, 104 (34%) were normal-weighted, 142 (46%) overweight and 62 (20%) obese. Among patients with BMI ! 25, blood loss increased (p ¼ 0.002) and the length of operation tended to be longer (p ¼ 0.072). No between-groups difference existed in fluid administration (p ¼ 0.319), urine output (p ¼ 0.425), or use of vasoactive drugs (p ¼ 0.815). There was no statistically significant difference in overall complications (p ¼ 0.122) between BMI groups. Blood loss >150ml was associated with both minor and major complications (p ¼ 0.022). Greater BMI moderated with the radiation therapy for higher risk of minor complications (OR 42.0, 95%CI 3.54-49.7, p ¼ 0.003). We conclude that greater BMI alone is not associated with a higher overall complication rate, but both overweight and obesity may be moderators for other risk factors.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Is there any difference in perioperative characteristics or postoperative complications between overweight, normal-weight and obese patients in delayed DIEP reconstructions?

Palve

Luukkaala

Kääriäinen

2021

Journal of Plastic Surgery and Hand Surgery

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“…Delaying the decision until both the medial and lateral perforators are exposed is known to lengthen operative time significantly. 20 As one of the main intentions of obtaining a CTA preoperatively is to reduce operating time, 4 this surprised us. To some extent, it could be explained by surgeons sticking to their habits.…”

Section: Discussionmentioning

confidence: 99%

Perforator Mapping Practice for Deep Inferior Epigastric Artery Perforator Flap Reconstructions: A Survey of the Benelux Region

Boer

Wingerden

Wever

et al. 2020

J Reconstr Microsurg

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Background Numerous new and novel imaging techniques for preoperative perforator selection in deep inferior epigastric artery perforator (DIEP) flap planning have been introduced. To what extent, these have been adopted into or replaced routine practice has hitherto remained unknown. The purpose of this study was to identify the currently preferred technique by reconstructive surgeons, the criteria that they regard as most relevant and what impact these have on the preoperative decision-making. Methods An online survey consisting of 25 questions was sent to members of the Benelux Societies for Plastic Surgery. Information regarding experience and preferred imaging modality was requested. Specific questions addressed the utilization of computed tomography angiography (CTA) and factors that could inform preoperative perforator selection. Results were anonymously collected, managed using REDCap, and analyzed using Chi-square statistic. Results Seventy-nine principal surgeons could be included. A variation in surgeon experience was observed. On CTA, the preferred imaging modality, large-caliber vessels, the location of the perforator in the flap, and its intramuscular course were considered the most significant criteria. Surgeons doing more than 20 DIEP flaps per year are less concerned about the distance of the perforator from the umbilicus (p = 0.003) but more likely to choose a medial perforator (p = 0.011). No statistical difference was found in surgeons' experience between those who would choose and use one specific (medial or lateral) perforator when they are analogous on CTA, and those who would delay the decision until both perforators have been exposed. Conclusion Advantages and disadvantages of the current practice of preoperative perforator selection by surgeons who are primarily responsible for harvesting a DIEP flap have been clearly identified. Indications are that these could be widely representative in which case, the quest for a protocol or modality that maximizes the benefit and minimizes harm in preoperative perforator mapping is urgently required.

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“…Reported studies have often focused on complications, costs or patients’ satisfaction [23–25]. An original recent study has proposed solutions to reduce DIEP operative time to make it more acceptable for patients [26]. Some authors have also tried to correlate the diameter of the vein to the flap weight in order to help surgeon in the choice of microvascular anastomosis technique [27].…”

Section: Discussionmentioning

confidence: 99%

Innovative DIEP flap perfusion evaluation tool: Qualitative and quantitative analysis of indocyanine green-based fluorescence angiography with the SPY-Q proprietary software

et al. 2019

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Background Perfusion-related complications remain the most common concern in DIEP flap breast reconstruction. Indocyanine green-based fluorescence angiography can be used for the real-time intra operative assessment of flap perfusion. The SPY Elite system is the most widely used device in this setting. The main objective was to describe the use of SPY-Q proprietary software to perform qualitative and quantitative analysis of flap perfusion. Methods This retrospective cohort study was performed at the Curie Institute between 2013 and 2017. We included patients undergoing unilateral DIEP flap breast reconstruction for whom indocyanine green-based angiography videos were of sufficient quality for analysis. Videos were recorded with the SPY Elite System and analyzed with SPY-Q proprietary software. Results We included 40 patients. We used real-time dynamic color analysis to describe three different patterns of flap perfusion. SPY-Q proprietary software provides quantitative flap perfusion parameters. Our quantitative analysis confirmed that zone I is the best perfused part of the flap and zone IV the less perfused one. There was no significant association between flap perfusion pattern and perforator anatomy, patients’ clinical characteristics or postoperative outcomes. After exploratory univariate analysis, quantitative perfusion parameters were significantly impaired in young patients with diabetes mellitus or under hormone therapy by tamoxifen. Conclusions We here describe a new approach to assess DIEP flap perfusion using the SPY Elite System proprietary software. It provides interesting qualitative and quantitative analysis that can be used in further studies to precisely assess DIEP flap perfusion.

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Time‐dependent factors in DIEP flap breast reconstruction

Abstract: The increase of flap weight, related perforators number, and venous drainage negatively influence OT. LC meaning systematic approach for surgery can optimize DIEP flap surgery efficiency.

Cited by 28 publications

References 29 publications

Is there any difference in perioperative characteristics or postoperative complications between overweight, normal-weight and obese patients in delayed DIEP reconstructions?

Is there any difference in perioperative characteristics or postoperative complications between overweight, normal-weight and obese patients in delayed DIEP reconstructions?

Perforator Mapping Practice for Deep Inferior Epigastric Artery Perforator Flap Reconstructions: A Survey of the Benelux Region

Innovative DIEP flap perfusion evaluation tool: Qualitative and quantitative analysis of indocyanine green-based fluorescence angiography with the SPY-Q proprietary software

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