Decreasing Donor Site Morbidity after Abdominal-Based Free Flap Breast Reconstruction: Long Term Results of a Randomized, Controlled Trial
Marilyn Ng, MD, Neal S. Topham, MD, Lisa M. Wetherhold, PA-C, Matthew J. Wetherhold, PA-C, Samuel Litwin, PhD, Eric I. Chang, MD.
Fox Chase Cancer Center, Rockledge, PA, USA.
PURPOSE: : The abdomen is the primary donor site for autologous tissue breast reconstruction. However, harvesting an abdominal flap may result in significant morbidity in terms of hernias, bulges, and weakness. Here, we present the long term follow-up of a randomized, controlled trial evaluating closure of the abdominal donor site.
METHODS: A randomized, controlled, non-inferiority study was conducted with all patients undergoing bilateral free flap breast reconstruction from the abdomen by the principal investigators. Patient demographics including age, BMI, medical comorbidities, past surgical history, smoking history, cancer stage, and neoadjuvant/adjuvant chemotherapy were assessed. Specifically, complications related to the abdominal donor site were also evaluated.
RESULTS: A total of 66 consecutive patients were included with 6 patients undergoing primary closure of the abdomen as the control group. Twenty patients underwent closure with polypropylene mesh and 40 patients had resorbable monofilament poly-4-hydroxybutyrate mesh (Phasix, Bard Davol Inc.) placement. There were no significant differences in patient demographics, comorbidities, or cancer treatment between the three groups. Early complications including wound dehiscence and seroma formation were significantly higher in the polypropylene and control groups compared to the Phasix group (20.0% vs. 16.7% vs. 0%, p<0.05 and 10.0% vs. 16.7% vs. 0%, p<0.001). Two of these patients with polypropylene mesh required operative debridement while all other patients were managed conservatively. Drain removal was also significantly faster in the resorbable mesh group compared to the polypropylene group (17.8 days vs. 21.2 days, p=0.004). Two patients with polypropylene mesh and one patient undergoing primary closure developed an abdominal bulge while no bulges or hernias were identified in the Phasix group in an average follow-up of 14.9 months (11.5% vs. 0%).
CONCLUSION: Hernias and bulges are some of the most concerning late complications associated with breast reconstruction with abdominal-based free flaps. The use of resorbable mesh significantly reduces the risks of early complications while also minimizing the risk of developing a hernia or bulge after long term follow-up beyond one year.
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