The Hidden Morbidity Of The Abdominal Donor Site After Autologous Breast Reconstruction
Michael Tecce, DO, Arturo J. Rios-Diaz, MD, Jessica R. Cunning, MBA, Cutler Whitely, BS, Harrison Davis, BS, Omar Elfanagely, MD, Robyn B. Broach, PhD, Joseph M. Serletti, MD, John P. Fischer, MD, MPH.
University of Pennsylvania, Philadelphia, PA, USA.
Purpose: Long-term follow-up is required to capture abdominal donor-site morbidities after autologous breast free flap reconstruction. We sought to explore long-term donor-site morbidity using a prospective longitudinal autologous breast free flap registry.
Methods: Patients who underwent muscle-sparing TRAM, DIEP, or SIEA flaps for autologous breast free flap reconstruction were identified in an institutional autologous breast free flap registry between 2006-2017. Outcomes included hernia/bulge (primary), surgical site infection, and small bowel obstruction. Descriptive statistics and backward-stepwise logistic regression determined factors associated with donor-site complications.
Results: Overall, 2,296 patients underwent abdominal-based autologous breast free flap reconstruction, comprising 96.9% of registry patients. Abdominal-based autologous breast free flaps were mainly muscle-sparing TRAM flaps (73.6%), followed by DIEP flaps (23.0%) then SIEA flaps (3.4%). Patients were a median age of 52 years-old (interquartile range [IQR] 45-58), 73.1% Caucasian, 39% obese, and 19.3% multimorbid; 65.9% received mesh. The median time to last encounter was 936 days (IQR 510-2619). The rates of hernia/bulge, surgical site infections, and small bowel obstruction were 8.1%, 3.2%, and 0.4%, respectively. Median time to hernia/bulge was 346 days (IQR 138-816). Of patients who had hernia/bulge diagnosis, 44.6% were surgically repaired and 10.8% of hernias recurred. Rates of hernia/bulge did not differ by mesh use (p=0.131). Selected factors associated with these complications are shown in the Table.
Conclusion: Hernias/bulges are prevalent after abdominal-based autologous breast free flap reconstruction and seem to be driven by delayed healing and mesh infections. Morbidity continues long after surgery with small bowel obstruction and hernia recurrence. New strategies are necessary to tackle this complex complication as mesh has not proven successful on its own.
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