Fluid overload & anastomosis failure anastomosis was revised, and the salvage percentage after revision of the anastomosis was 55%. Of the 11 anastomosis revisions, two patients had arterial occlusion, which was detected early in the postoperative period by means of absent Doppler signal. In the remaining nine patients, venous stasis was the reason for reoperation. This was usually detected at a later stage due to a positive Doppler signal form the intact arterial anastomosis. Anastomosis failure was recognized when delayed macroscopic changes resulting from venous stasis occurred. These flaps had a prolonged ischemia time and subsequent reperfusion injury. As consequence, these patients had a high rate of TFL and major flap complication (ma‐FC). Five out of nine venous anastomosis revisions resulted in TFL. In addition, all four patients with successful venous anastomosis revision developed ma‐FC, requiring a second return to operating theatre for debridement. Table 2.1 Definitions and abbreviations of complications. Abbreviation Definition Severity Cosmetics mi‐FC Minor flap complications: fat Minor None to minor effect on necrosis (without skin loss) or cosmetic result small flap necrosis ma‐FC Major flap complication: partial Major; requiring Major effect on cosmetic flap necrosis (>5%) reoperation: debridement result in theatre TFL Total flap loss Severe Flap failure to reconstruct, usually worse cosmetic appearance RA Revision of anastomosis Major; requiring No effect on cosmetic result if reoperation: redo of the procedure is successful and no anastomosis or other complication occur repositioning In addition, 13 patients experienced ma‐FC, which eventually resulted in a poor cosmetic appearance. This resulted in a total of 17 patients with ma‐FC (15%; Table 2.2). There was an overall good cosmetic result in 79% of patients and an inferior cosmetic result in 15% of patients. Six percent of patients experienced TFL. In two of these patients, a musculocutaneous latissimus dorsi flap in conjunction of a breast implant was used for reconstruction at a later stage. Three other patients needed a split skin graft for definitive closure of the defect. Risk factors such as obesity (defined as BMI>28), radiotherapy and chemotherapy were not associated with complications. Smoking was not found to be a significant risk factor for the development of PFL in this study.5. However, smoking history was not meticulously recorded in this study population. 29
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