Predictive risk factors of free flap thrombosis in breast reconstruction surgery

Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication...

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Bibliographic Details
Published in:Microsurgery 2014-11, Vol.34 (8), p.589-594
Main Authors: Masoomi, Hossein, Clark, Emily G., Paydar, Keyianoosh Z., Evans, Gregory R.D., Nguyen, Audrey, Kobayashi, Mark R., Wirth, Garrett A.
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Aged, 80 and over
Breast Diseases - complications
Breast Diseases - pathology
Breast Diseases - surgery
Female
Hospitalization - statistics & numerical data
Humans
Mammaplasty - adverse effects
Mammaplasty - statistics & numerical data
Middle Aged
Retrospective Studies
Risk Factors
Surgical Flaps - adverse effects
Surgical Flaps - blood supply
Surgical Flaps - statistics & numerical data
Thrombosis - epidemiology
Time Factors
United States
Young Adult
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Summary:Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage. © 2014 Wiley Periodicals, Inc. Microsurgery 34:589–594, 2014.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.22250