Abstract
Free tissue-transfer with DIEAP (Deep inferior epigastric artery perforator) flaps is one of the best forms of autologous breast reconstruction. It is a microsurgical procedure and surgeons have remained guarded over selecting patient with co-morbidities. This chapter looks into the relevance of patient related co-morbid conditions and the associated complication rates. Despite having significantly higher complications in form of delayed donor area wound healing in active smokers and higher total flap loss in obese patients the overall complication rate compared to other reconstructive procedures is low. Microsurgical reconstruction with DIEAP flap results in an excellent aesthetic outcome with high patient satisfaction, but low complication rates, even in patients with known co-morbid conditions.
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References
Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42(2):645–648
Allen RJ, Treece P (1994) Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 32(1):32–38
Blondeel PN, Boeckx WD (1994) Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery. Br J Plast Surg 47(7):495–501
Nahabedian MY, Momen B, Galdino G, Manson PN (2002) Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap and outcome. Plast Reconstr Surg 110(2):466–475
Lawrence WT, Murphy RC, Robson MC, Heggers JP (1984) The detrimental effect of cigarette smoking on flap survival: an experimental study in the rat. Br J Plast Surg 37(2):216–219
Heliovaara M, Karvonen MJ, Punsar S (1978) Smoking, carbon monoxide and atherosclerotic disease. Br Med J 1(6108):268–270
Chang DW, Reece GP, Wang B, Robb GL, Miller MJ, Evans GR, Langstein HN, Kroll SS (2000) Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plast Reconstr Surg 105(7):2374–2380
Goldminz D, Bennet RG (1991) Cigarette smoking and flap and full-thickness graft necrosis. Arch Dermatol 127(7):1012–1015
van Adrichem LN, Hoegen R, Hovius SE, Kort WJ, van Strik R, Vuzevski VD, van der Meulen JC (1996) The effect of cigarette smoking on the survival of free vascularized and pedicled epigastric flaps in rats. Plast Reconstr Surg 97(1):86–96
Manchio JV, Litchfield CR, Sati S, Bryan DJ, Weinzweig J, Vernadakis AJ (2009) Duration of smoking cessation and its impact on skin flap survival. Plast Reconstr Surg 124(4):1105–1117
Stephen CR (1986) Risk factors and outcome in elderly patients: an epidemiologic study. In: Stephen CR, Assaf RAE (eds) Geriatric anaesthesia: principles and practise. Butterworths, Boston
Chick LR, Walton RL, Reus W, Colen L, Sasmor M (1992) Free flaps in the elderly. Plast Reconstr Surg 90(1):87–94
Kroll SS, Netscher DT (1989) Complications of TRAM flap breast reconstruction in obese patients. Plast Reconstr Surg 84(6):886–892
Paige KT, Bostwick J 3rd, Bried JT, Jones G (1998) A comparison of morbidity from bilateral, unipedicled and unilateral unipedicled TRAM flap breast reconstruction. Plast Reconstr Surg 101(7):1819–1827
Alderman AK, Wilkins EG, Kim HM, Lowery J (2002) Complications in postmastectomy breast reconstruction: two years results of the Michigan Breast Reconstruction Outcome Study. Plast Reconstr Surg 109(7):2265–2274
Fee-Fulkerson K, Conaway MR, Winer EP, Fulkerson CC, Rimer BK, Georgiade G (1996) Factors contributing to patient satisfaction with breast reconstruction using silicone gel implants. Plast Reconstr Surg 97(7):1420–1426
Vyas RM, Dickinson BP, Fastekjian JH, Watson JP, DaLio AL, Crisera CA (2008) Risk factors for abdominal donor – site morbidity in free flap breast reconstruction. Plast Reconstr Surg 121(5):1519–1526
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© 2016 Springer International Publishing Switzerland
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Seidenstuecker, K., Munder, B., Mahajan, A.L., Andree, C. (2016). Microsurgical Breast Reconstruction in Presence of Co-morbidities. In: Shiffman, M. (eds) Breast Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-319-18726-6_151
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DOI: https://doi.org/10.1007/978-3-319-18726-6_151
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-18725-9
Online ISBN: 978-3-319-18726-6
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