Chapter 2 chest wall irradiations and chemotherapy. Flap characteristics, e.g. flap weight, reconstructed breast weight, ischemia time and incidence of postoperative complications, were noted. Outpatient recording charts were used to detect any late complications such as wound dehiscence, minor partial flap loss or fat necrosis. Using the anesthesia operative/recovery charts, type (crystalloid or colloid) and volume of fluid therapy and hemodynamics parameters were meticulously recorded. These parameters were recorded at a 15‐min interval during surgery followed by hourly recording up to discharge from the recovery area 24 h after surgery. Patient and flap temperature were recorded using the same time interval. The use of vasoactive medication was also recorded during this period. After completion of the anastomosis, all patients received intravenous Dextran (30 cm3/h); this is commonly used by microsurgeons to decrease vascular thrombosis. All data were presented as mean values ± SEM. SPSS was used for statistical analysis. Repeated measures analysis of variance was used for analysis of all repeated measurements. Student's t test was used for analyzing quantitative parameters. Chi‐ square test was used for categorical data. A P value (two‐tailed) was considered statistically significant. Results In the 108 consecutive patients, the free TRAM flap was used for secondary unilateral breast reconstruction. The anesthesia/recovery chart was lost in two cases and was incomplete in two cases. These four cases were excluded from further analysis. For the remaining 104 patients, the perioperative data was thoroughly recorded and found suitable for inclusion in the study. Mean age at time of operation was 48.4±0.8 (range, 27–68) years. Body mass index (BMI) was 26.3±0.5 (range, 17.5–32.4) kg. Fifty percent of patients received radiotherapy, and 67% of the patients received chemotherapy preoperatively. Thirty‐ seven percent of patients received both chemo‐ and radiotherapy. Mean flap ischemia time was 57.6±3.6 (range, 32–120) min. History of smoking was repentantly recorded in only 50% of the patients. Of these patients, 40.7% were non‐smokers, 24.1% were active smokers at the time of surgery and 35.2% stopped smoking prior to surgery In Table 2.1, the definitions for various complications are specified. In 59 patients (57%), the procedure was performed uneventful. Seventeen patients (16%) had minor flap complications (mi‐FC), which were managed conservatively, and patients recovered with either no or just minor negative effects on the aesthetic results. Twenty‐nine patients had complications requiring return to the operating room. Two cases returned because of postoperative bleeding; these two patients recovered with no further complications. In one patient, failure of the anastomosis was discovered too late, and this patient had total flap loss (TFL). In 11 patients (11%), the 28
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