Chapter 5 All data are presented as mean values ± SEM. The SPSS program was used for statistical analysis. LDF data with the TRAM flap on its vascular pedicle are shown separately. After the anastomosis, the LDF data measured are displayed hourly up to 5 hours after reperfusion, and daily mean values are shown up to 4 days after surgery. Repeated‐ measures ANOVA was used for analysis of all the repeated measurements. Mann‐ Whitney U test was used for analysis of the individual quantitative parameters. For nonparametric data containing more than 2 groups, the Kruskal‐Wallis test was used for analysis. Fisher exact test was used for categorical data. A P value (2‐tailed) was considered statistically significant. Results Mean age at time of operation was 48.4±1.8 (range, 27–59) years and mean QI was 26.7±0.7 (range 22–35). Incidence of chemotherapy (17/21; 81%), radiotherapy (11/21; 52%), and smoking (7/21; 33%) was high (Table 5.4). After trimming of the abdominal flap, the mean FW used for breast reconstruction was 821±59 (range, 374–1451) g. The weight of the used flap divided by the FWU was 821±59/959 ± 81 g, which gives an average of 88%±3% (range, 64%–100%). One hundred percent of the flap was used for reconstruction in 8 cases (40%). Mean flap ischemia time was 52±3 (range, 32–100) minutes (Table 5.5). The measurement location of both measurement sites remained in the reconstructed breast in all patients. FC occurred in 9 patients (43%). Three of these patients had M‐PFL<3%, which was treated conservatively. Six patients with M‐PFL required surgical debridement in the operating theater (29%). Table 5.6 shows the individual data of these patients. Patients were planned ±3 months after the breast reconstruction to undergo the symme‐ trization procedure to achieve final esthetic result. Procedures then performed to achieve final satisfactory esthetic results were predominantly ptosis correction of the contralateral breast. All FC occurred in zone IV, with the exception of 2 cases in which M‐PFL occurred in zones III and IV. FC occurred at a higher rate in the patients with an active smoking history compared with nonsmokers (P=0.016). In addition, M‐PFL occurred only in active smokers (P<0.000). FC was higher in obese patients. Age, chemotherapy, and radiotherapy did not affect the outcome. A high flap weight (>800 g) was not associated with FC (P=0.08) or with M‐PFL (P=0.149) requiring surgical debridement. A high flap weight in combination with active smoking was more clearly associated with FC (P=0.008) and patients with M‐PFL (P<0.000). Percent age of FWU (with >90%; parts of zone IV are included in the reconstructed breast) as a risk factor was not significantly higher in patients with FC or in patients with M‐PFL. The duration of the ischemia period did not have any effect on outcome in this study (Table 5.5). 76
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