A study of perfusion of the distal free TRAM flap Table 4.3 Preoperative risk factors and patient demographics (* Mean±SD). All patients (N = 30) FC (N = 11) No FC (N = 19) P‐value Smoking# 8 (27%) 6 (55 %) 2 (11 %) 0.028 Radiation# 12 (40%) 7 (37 %) 5 (45 %) 0.119 Chemotherapy# 23 (70%) 9(82 %) 14 (74 %) 1.000 *Age (years)▲ 47 (± 8) 47 (± 8) 47 (± 8) 0.914 *BMI▲ 26.1 (± 3.4) 27.0 (± 2.4) 25.8 (± 3.8) 0.349 **Obesity # 9 (30%) 3 (27 %) 6 (32 %) 1.000 *Length of stay (days)▲ 5.8 (± 1.2) 6.4 (± 1.7) 5.5 (± 0.6) 0.196 ** BMI greater than 28 was defined as obese; # Statistical analysis was performed with the Fisher’s exact test. ▲ Mann‐Whitney U test (All p‐values are 2‐tailed). The number of perforators included in the muscle‐sparing free TRAM flap ranged from two to four. Muscle lateral to the lateral perforators was left intact. Out of 30 patients 11 experienced FC all of which were located in zones III/ IV (11/30; 37%). Two patients had PFL>10% (in zone III and IV) and four patients had PFL 5–10% (only zone IV) (Table 4.4). These patients were planned for acute debridement and symmetrization shortly after the first procedure. One of the patients with PFL>10% needed a split skin graft (SSG) in order to close the partial defect and was considered to have a poor result. Five patients had PFL<5% (in zone IV) and were treated conservatively and were planned, with the other patients without FC, to undergo the symmetrization procedures ±3 months after the breast reconstruction. A final good aesthetic result was obtained in all but the one patient who required the SSG to cover the partial defect (96%). Procedures performed to achieve final satisfactory aesthetic results were predominantly ptosis correction of the contralateral breast and if needed scar revision of the reconstructed breast in some patients. Table 4.4 Flap datasheet (Means ± SD). All patients (N=30) FC (N=11) No FC (N=19) P‐value *Flap weight (grams) ▲ 801 ± 241 905 ± 246 741 ± 222 0.081 **FWU (%) ▲ 86 ± 14 86 ± 15 86 ± 13 0.892 Medial border of zone IV intact intact intact ‐ Use of abdominal flap (> 95 %) # 8 (27 %) 3 (10 %) 5 (17 %) 1.000 Ischemia period (minutes) ▲ 54 ± 22 50 ± 16 57 ± 24 0.485 * Flap weight used for breast reconstruction. **FWU: percentage of abdominal flap weight used for reconstruction. ▲ Mann‐Whitney U test was used for statistical analysis. # Fisher exact test used. (All p‐values are 2‐tailed). Risk factors included in the analysis were obesity (defined as BMI>28), smoking, radiotherapy, chemotherapy, and high flap weight (Table 4.3). Confirming previous reports, smoking was found to be a significant risk factor for the development of FC (P=0.028). Flap weight was somewhat higher in patients with FC, although not significant. Analysis of BMI and percentage of the abdominal flap (FWU) used for reconstruction revealed no significant differences. Analysis of the other possible 61
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