Risk factors and blood flow in free TRAM flap Table 5.4 Patient demographics. All patients No FC FC P‐value M‐PFL P‐value (N=21) (N=12) (N=9) (N=6) # Smoking 7 (33.3%) 1 (8.3%) 6 (66.7%) 0.016 6 (100%) # Radiation 11 (52.4%) 4 (33.3%) 7 (77.8%) 0.080 4 (66.7%) 0.635 # Chemotherapy 17 (81.0%) 8 (66.7%) 9 (100%) 0.104 6 (100%) 0.281 # Obesity (kg.m^2) 25 5 (23.8%) 5 (41.7%) 0 (0%) NP 0 (0%) NP 25‐29 13 (61.9%) 5 (41.7%) 8 (88.9%) 0.036** 4 (66.7%) 0.262** ≥30$ 3 (14.3%) 2 (16.7%) 1 (11.1%) 0.045*** 2 (33.3%) 0.114*** ▲ Age (years)* 48.4±1.8 (27‐59) 49.1±2.7 (32‐59) 47.9±2.4 (27‐58) 0.695 50.8±2.0 (46‐57) 0.510 # $ Cut‐off (≥55 years) 7 (33.3%) 4 (33.3%) 3 (43%) 1.000 3 (43%) 1.000 ▲ Length of stay (nights)* 5.1±0.3 (3‐8) 4.7±0.2 (4‐6) 5.6±0.6 (3‐8) 0.279 8.2±0.6 (6‐10) 0.104 NP= not possible. FC=Flap complications. m‐PFl = Major Flap Loss. * Mean ± SEM. # Statistical analysis was performed with the Fisher’s exact test. ▲Mann‐Whitney U test (All p‐values are 2‐tailed). $Categorical data with cut‐off points used for LDF analysis (Fisher exact test) is also shown. ** BMI of 25‐30 compared to a BMI of 25. *** BMI of ≥25 compared to BMI Table 5.5 Flap characteristics (Means±SD). All patients FC No FC p‐value (N=21) (N=9) @ (N=12) @ ▲ FW (grams) 821±59 (374‐1451) 949±82 (600‐1451) 725±73 (374‐1216) 0.069 # FW> 800$ 11 (52%) 7 (64%) 4 (36%) 0.080 ▲ FWU (%) 88±3 (64‐100) 90±3 (72‐100) 86±4 (64‐100) 0.615 # $ FWU> 90% 11 (52%) 5 (45%) 6 (55%) 1.000 ▲ Ischemia (min.) 52±3 (32‐100) 49±4 (32‐66) 54±5 (38‐100) 0.695 # $ Ischemia> 60 7 (33%) 3 (43%) 4 (57%) 1.000 FW= Flap weight used for breast reconstruction. FWU= percentage of abdominal flap weight used for reconstruction. $Categorical data with cut‐off points used for LDF analysis is also shown. @The percentages in these columns represent the percentage of persons with the relevant risk factor. ▲Mann‐Whitney U test was used for statistical analysis. #Fisher exact test used. (All p‐values are 2‐tailed) No significant differences were observed in hemodynamics when comparing patients with FC to those without FC. Room temperature was measured every 15 minutes during the first 24 hours after surgery and revealed no differences when comparing patients with the various risk factors to those without these risk factors. After reconstruction, the flaps with PFL seemed to have a lower flap temperature. This was, however, not significant. Analysis of blood‐flow measurements with the flap on its pedicle (after an acclimatization period of 10 minutes) revealed no significant differences in zone I when comparing patients with or without the various factors studied. In zone IV, a lower blood flow was measured in flaps weighing over 800 g compared with flaps weighing less than 800 g (Figure 5.2; P=0.012). 77
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