| Part I:Retrospective Analysis of103Cases of Free Abdominal flap for Breast Reconstructions[Objective] We retrospectively reviewed103cases of free Abdominal flaps for breast reconstruction performed in FUSCC. Clinical outcomes and reconstructive techniques are discussed.[Methods] From November,2006to December,2012, we used free Abdominal flaps to perform103cases of breast reconstruction on101female patients after mastectomy through microsurgical techniques. We observed the safety and complications.[Results] We performed1case of SIEA flap breast reconstruction and102cases of flaps based on deep inferior epigastric vessels. According to the classification of muscle sparing,3cases were MS-0which were also called free TRAM flaps,1case was MS-1,46cases were MS-2and the rest52cases were MS-3which were also called DIEP flaps. The average number of perforators included in the flap was3. The average operation time was7.86hours. The average time of ischemia was1.5hours. Seven cases of vessel crisis occurred and3of them were venous thrombosis and3cases were venous kink and another one case was because the superficial inferior epigastric artery was too thin. Four of them were salvaged, and the other3failed. In this initial experience of free flap breast reconstruction, the success rate was97.1%. The median follow-up time was12months. The incidence of fat necrosis was31.1%. Abdominal bulge occurred in3.9%of patients. None of the patients developed abdominal hernia. Postoperative infection rate was7.8%. The median interval between surgery and the first cycle of adjuvant chemotherapy was19days. One case of distant metastasis, but no local recurrence was reported.[Conclusions] Although free Abdominal flap breast reconstruction requires microsurgical techniques and equipments, and the learning curve does exist, free Abdominal flap breast reconstruction has a high success rate with oncological safety and few complications. Part II:Risk Factors of Fat Necrosis in Free Abdominal flap for Breast Reconstructions[Objective] Fat necrosis is one of the most common complications of free abdominal flap breast reconstruction. Although it is a minor complication, it compromises cosmetic results and causes anxiety of cancer recurrence. Lots of factors were proved to increase the risk of fat necrosis. However there were still controversies. So we would like to review88successful cases of free abdomianl flap breast reconstructions with follow-ups to determine the incidence rate of this complication and its risk factors.[Methods] We retrospectively studied the88consecutive cases of free Abdominal flap breast reconstructions in FUSCC from November,2006to September,2012. Data were collected from patients’surgical records, ward reports and clinic notes, etc.[Results] The incidence rate of fat necrosis was36.4%. Generally it was a manageable and minor complication. In these32lesions,21of them disappeared or were alleviated. Adjuvant chemotherapy significantly increased the risk of fat necrosis by4.762times (multivariate logistic regression model;95%CI1.767-12.831; p=0.002). Timing of reconstruction showed significant association with fat necrosis only after univariate analysis. Perforator number, degree of muscle sparing, adjuvant radiation and perioperative problems were not independent predictors of fat necrosis in our study. There was no evidence that what kind of cytotoxic agent was the cause. Patients with fat necrosis seemed to start adjuvant chemotherapy earlier with an average interval of17.8days compared to21.7days in those without fat necrosis.(Independent sample t-test; p=0.128)[Conclusions] Adjuvant chemotherapy was independent predictive factor of fat necrosis. In China where the indication of chemotherapy was generally wide, we should limit the indication in patients with controversial benefit of chemotherapy. And when deciding the timing of reconstruction, besides considering about the negative effect of postoperative radiation we should also take chemotherapy into account. |
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