Articles & Issues Collections CME Supplements Videos Social Journal Info
Skip Navigation LinksHome > December 2013 - Volume 132 - Issue 6 > Comprehensive Analysis of Donor-Site Morbidity in Abdominall...
Text sizing:
A
A
A
Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3182a805a3
Breast: Original Article

Comprehensive Analysis of Donor-Site Morbidity in Abdominally Based Free Flap Breast Reconstruction

Chang, Edward I. M.D.; Chang, Eric I. M.D.; Soto-Miranda, Miguel A. M.D.; Zhang, Hong Ph.D.; Nosrati, Naveed M.D.; Robb, Geoffrey L. M.D.; Chang, David W. M.D.

Collapse Box

Abstract

Background: This study aimed to provide a comprehensive analysis of factors that might contribute to abdominal donor-site morbidity after abdominally based free flap breast reconstruction.

Methods: The authors performed a retrospective analysis of all abdominally based free flap breast reconstructions performed from January of 2000 through December of 2010 at their institution.

Results: Overall, 89 of 1507 patients developed an abdominal bulge/hernia (unilateral: 57 of 1044; bilateral: 32 of 463). A unilateral transverse rectus abdominis musculocutaneous (TRAM) flap was significantly more likely to develop an abdominal bulge/hernia than was a muscle-sparing TRAM flap or a deep inferior epigastric perforator (DIEP) flap (9.9 percent versus 3.7 percent versus 5.9 percent; p = 0.004). However, there was no difference in the risk of developing an abdominal bulge/hernia between a muscle-sparing TRAM and a DIEP flap (p = 0.36). Patients who underwent bilateral reconstructions were 1.35 times more likely to develop an abdominal bulge/hernia than patients who underwent unilateral reconstruction, but the difference was not significant. Harvesting more fascia as occurs when both medial and lateral rows are used was significantly associated with need for mesh (p < 0.0001). Overall, placement of mesh for fascia closure reduced the odds of occurrence of bulge/hernia by 70 percent compared with primary fascia closure.

Conclusions: There was no significant difference in the risk of developing abdominal bulge/hernia between bilateral versus unilateral breast reconstruction. For abdominally based free flap breast reconstruction, the extent of the fascia harvested, how it is repaired, and the amount of muscle preserved might play an important role in donor-site morbidity.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

©2013American Society of Plastic Surgeons

Login

Article Tools

Share