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Is a second free flap still an option in a failed free flap breast reconstruction?

Moustapha Hamdi, Patricio Andrades, FILIP THIESSEN UGent, Filip Stillaert, Nathalie Roche, Koenraad Van Landuyt UGent and Stan Monstrey UGent (2010) PLASTIC AND RECONSTRUCTIVE SURGERY. 126(2). p.375-384
abstract
Background: Salvage of a faded autologous breast reconstruction is a complex and challenging problem. The purpose of this study was to analyze the indications, methods. and outcomes of tertiary surgery in patients with a failed autologous breast reconstruction. Methods: A retrospective Chart review was performed for all patients who underwent breast reconstruction with autologous tissue performed by the senior author (M.H.) between 2002 and 2009. Special emphasis was made to evaluate the first reconstruction performed, causes of failure, indications for tertiary reconstruction, and Outcomes. A preoperative hematologic workout was performed. For patients who were classified within the highest group of thromboembolism, specific prophylactic measurements were taken for the tertiary surgery. Results: Of 688 patients who underwent autologous breast reconstruction, a total of 14 patients required tertiary breast reconstruction. Hypercoagulability was found in three patients resulting from disorders such as lupus anticoagulant positivity and antiphospholipid syndrome. Six patients (43 percent) underwent a combination of local skin flaps and/or implant. reconstructions Eight patients (57 percent) underwent nine microvascular breast reconstructions: five superior gluteal artery perforator flaps, three transverse myocutaneous gracilis flaps, and one deep inferior epigastric artery perforator flap. Two of nine flaps (22 percent) required quaternary reconstnictions because ()fa failure of the second free flap. Additional corrections such as revision lipofilling, scar revision, contralateral breast shaping, implant change, and capsulotomies were performed in 92.7 percent of the patients, with a mean follow-up of 37 months (range, 6 months to 7 years). Conclusions: Tertiary surgery after autologous breast reconstruction failure has limited options and further reoperations are often needed. Careful patient history and selective blood tests may reveal hidden coagulation disorders. When a second free flap is planned, primary and secondary antihrombotic therapy should be considered. (Plast. Reconstr Surg 126. 375, 2010)
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
FAILURE, RECIPIENT VESSELS, UNRECOGNIZED HYPERCOAGULABILITY, ANTIPHOSPHOLIPID SYNDROME
journal title
PLASTIC AND RECONSTRUCTIVE SURGERY
Plast. Reconstr. Surg.
volume
126
issue
2
pages
375 - 384
Web of Science type
Article
Web of Science id
000280143800005
JCR category
SURGERY
JCR impact factor
2.635 (2010)
JCR rank
38/186 (2010)
JCR quartile
1 (2010)
ISSN
0032-1052
DOI
10.1097/PRS.0b013e3181de2213
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1030721
handle
http://hdl.handle.net/1854/LU-1030721
date created
2010-08-31 16:17:20
date last changed
2016-12-19 15:42:12
@article{1030721,
  abstract     = {Background: Salvage of a faded autologous breast reconstruction is a complex and challenging problem. The purpose of this study was to analyze the indications, methods. and outcomes of tertiary surgery in patients with a failed autologous breast reconstruction.
Methods: A retrospective Chart review was performed for all patients who underwent breast reconstruction with autologous tissue performed by the senior author (M.H.) between 2002 and 2009. Special emphasis was made to evaluate the first reconstruction performed, causes of failure, indications for tertiary reconstruction, and Outcomes. A preoperative hematologic workout was performed. For patients who were classified within the highest group of thromboembolism, specific prophylactic measurements were taken for the tertiary surgery.
Results: Of 688 patients who underwent autologous breast reconstruction, a total of 14 patients required tertiary breast reconstruction. Hypercoagulability was found in three patients resulting from disorders such as lupus anticoagulant positivity and antiphospholipid syndrome. Six patients (43 percent) underwent a combination of local skin flaps and/or implant. reconstructions Eight patients (57 percent) underwent nine microvascular breast reconstructions: five superior gluteal artery perforator flaps, three transverse myocutaneous gracilis flaps, and one deep inferior epigastric artery perforator flap. Two of nine flaps (22 percent) required quaternary reconstnictions because ()fa failure of the second free flap. Additional corrections such as revision lipofilling, scar revision, contralateral breast shaping, implant change, and capsulotomies were performed in 92.7 percent of the patients, with a mean follow-up of 37 months (range, 6 months to 7 years).
Conclusions: Tertiary surgery after autologous breast reconstruction failure has limited options and further reoperations are often needed. Careful patient history and selective blood tests may reveal hidden coagulation disorders. When a second free flap is planned, primary and secondary antihrombotic therapy should be considered. (Plast. Reconstr Surg 126. 375, 2010)},
  author       = {Hamdi, Moustapha and Andrades, Patricio and THIESSEN, FILIP and Stillaert, Filip and Roche, Nathalie and Van Landuyt, Koenraad and Monstrey, Stan},
  issn         = {0032-1052},
  journal      = {PLASTIC AND RECONSTRUCTIVE SURGERY},
  keyword      = {FAILURE,RECIPIENT VESSELS,UNRECOGNIZED HYPERCOAGULABILITY,ANTIPHOSPHOLIPID SYNDROME},
  language     = {eng},
  number       = {2},
  pages        = {375--384},
  title        = {Is a second free flap still an option in a failed free flap breast reconstruction?},
  url          = {http://dx.doi.org/10.1097/PRS.0b013e3181de2213},
  volume       = {126},
  year         = {2010},
}

Chicago
Hamdi, Moustapha, Patricio Andrades, FILIP THIESSEN, FILIP STILLAERT, NATHALIE ROCHE, Koenraad Van Landuyt, and Stan Monstrey. 2010. “Is a Second Free Flap Still an Option in a Failed Free Flap Breast Reconstruction?” Plastic and Reconstructive Surgery 126 (2): 375–384.
APA
Hamdi, M., Andrades, P., THIESSEN, F., STILLAERT, F., ROCHE, N., Van Landuyt, K., & Monstrey, S. (2010). Is a second free flap still an option in a failed free flap breast reconstruction? PLASTIC AND RECONSTRUCTIVE SURGERY, 126(2), 375–384.
Vancouver
1.
Hamdi M, Andrades P, THIESSEN F, STILLAERT F, ROCHE N, Van Landuyt K, et al. Is a second free flap still an option in a failed free flap breast reconstruction? PLASTIC AND RECONSTRUCTIVE SURGERY. 2010;126(2):375–84.
MLA
Hamdi, Moustapha, Patricio Andrades, FILIP THIESSEN, et al. “Is a Second Free Flap Still an Option in a Failed Free Flap Breast Reconstruction?” PLASTIC AND RECONSTRUCTIVE SURGERY 126.2 (2010): 375–384. Print.