Chapter 5 analyze the effect of various patient and flap characteristics on the free TRAM microcirculation and clinical outcome. Table 5.1 Literature overview of flap complication incidence. Year Flap Type (N) Flap complications (%) Inclusion of Zone IV Ducic et al.1 2005 Pedicled TRAM (224) PFL (9.8), FN (17.9) N. R. DWH (6.7) Scheer et al.2 2006 DIEP flap (84) PFL (1.3), FN (42.9) N. R. Free TRAM flap (46) PFL (6.5), FN (8.7) Padubidri et al.3 2001 Pedicled TRAM (198) PFL (5.0), FN (10.6) N. R. Gill et al.4 2004 DIEP (758) PFL (2.5), FN (10.6) Excised Blondeel et al.5 1999 DIEP (100)* PFL (7.0), FN (6.0) Variable inclusion Kroll6 2000 DIEP flap I (8)# PFL (37.5), FN (62.5) Included DIEP flap II (23)# PFL (8.7), FN (17.4) Excised Free TRAM flap (279) PFL (2.2), FN (12.9) N. R. Banic et al.7 1995 Free TRAM flap (123) PFL (6.6), FN (8) Included Cheng et al.8 2006 DIEP (74) PFL (2.7), FN (4.1) Included Nahabedian et al.9 2002 DIEP flap (17) PFL (0.0), FN (11.7) N. R. Free TRAM flap (118) PFL (0.0), FN (11.9) Knight et al.10 2006 Free TRAM flap (76) PFL (1.0), FN (13.7) N. R. DWH = delayed wound healing. N.R. = Not reported * In the latter part of the study zone IV was systematically discarded. # In DIEP I patients had the same selection criteria as free TRAM flap patients. In DIEP II patients were selected to avoid risk factors and less then 70 % of the abdominal flap was used in the reconstruction. Table 5.2 Significant risk factors for flap complications in literature (P‐values). Flap Smoking Obesity CHTH RTx* Age HFW Gill et al.4 DIEP S NS NS S* NS NS Nahabedian et al.9 Free TRAM NS S NA NA NA NA DIEP NS S NA NA NA NA Ducic et al.1 Ped. TRAM S# S NS NS NA NA Banic et al.7 Free TRAM NS NS NS NS NA NA Chang et al.8,11 Free TRAM NS S@ NA NA NA NA Selber et al.12 Free TRAM S S$ NS NS NA NA Tran et al.13 Ped. TRAM NA NA NA S* NA NA Metha et al.14 Ped. TRAM NA NA NA NS NA NA Javaid et al.15 Various ** NA NA NA S* NA NA S=Significant, NS=Not significant, HFW=High flap weight, NA=Not available and HT=Hypertension. *Post reconstructive irradiation. #significant for overall flap complications, not for just PFL or fN. ** Various types of free flaps. @Significance in overall flap complications, no significance was found for PFL. $Significant increase in mastectomy skin flaps necrosis. Patients and methods We prospectively evaluated 21 patients in this clinical study. The institutional ethical committee of the Maastricht University Hospital approved the study protocol. Written informed consent was obtained from all patients. Exclusion criteria were a lower 72
Microsoft Word - chapter 0 v1 DB.doc
To see the actual publication please follow the link above