The authors retrospectively reviewed 500 free TRAM flaps performed between 1992 and 2003. This cohort was subdivided based on smoking history, obesity, preoperative chemotherapy, preoperative radiation therapy, peripheral vascular disease, chronic obstructive pulmonary disease (COPD), and hypertension, and compared surgical complication rates. Measured complications included fat necrosis, mastectomy flap necrosis, abdominal flap necrosis, partial TRAM flap loss, wound infection, hematoma, seroma, vessel thrombosis, and abdominal hernia. χ2 analysis and Fisher exact test were performed to determine differences between groups, and linear regression models were used to predict the risk factors of surgical complications.
Smokers were more likely to have a higher incidence of wound infection (P = 0.01), mastectomy flap necrosis (P = 0.015), abdominal flap necrosis (P = 0.033), and fat necrosis (P = 0.01). Obese patients were more likely to have higher rates of mastectomy flap necrosis (P = 0.01) and hematoma (P = 0.01). Patients with peripheral vascular disease were more likely to have a higher incidence of wound infection (P = 0.031), and patients with preoperative radiation therapy were more likely to have a higher incidence of seroma (P = 0.043). Logistic regression showed that smoking was found to be a risk factor for fat necrosis (P = 0.006), wound infection (P = 0.002), mastectomy flap necrosis (P = 0.039), and abdominal flap necrosis (P = 0.042). Obesity was a risk factor for mastectomy flap necrosis (P = 0.002). Peripheral vascular disease was a risk factor for wound infection (P = 0.032).
Awareness of risk factors and associated complications will lead to modification and individualization of surgical techniques in an attempt to limit these complications and continually improve outcomes.
A review of 500 TRAM flap breast reconstructions showed that obesity was a risk factor for mastectomy flap necrosis while peripheral vascular disease was a risk factor for wound infection. Smoking was a risk factor for both.
From the *Division of Plastic Surgery and †Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA; and the ‡Division of Plastic Surgery, Strong Memorial Hospital, Rochester, NY.
Received January 19, 2006 and accepted for publication January 24, 2006.
Presented at the Annual Meeting of the Northeastern Society of Plastic and Reconstructive Surgeons, Washington, DC, November 3–6, 2005.
Reprints: Jesse C. Selber, MD, MPH, University of Pennsylvania, Department of Plastic Surgery, 10 Penn Tower, 3400 Spruce St., Philadelphia, PA 19104. E-mail: firstname.lastname@example.org.