Chapter 6 patients, there was a follow‐up period of at least 6 weeks after the procedure, sufficient to detect postoperative complications. Mean age at the time of surgery was 48±1 years and mean body mass index was 24±1. After adaptation of the abdominal flap, the mean weight of flap used for breast reconstruction was 751±47 g. The location of measurement sites in zone I and zone IV remained accessible for measurement in the reconstructed breasts in both groups. Mean flap ischemia time was 52±4 minutes. The prevalence of other risk factors such as radiotherapy and chemotherapy was distributed evenly between the arginine group and the alanine group (Table 6.1) and did not have an effect on clinical outcome. From 18 patients, seven (30 percent) experienced partial flap loss, which was always located in zone III or IV (Table 6.3). Two of these patients were located in the arginine group, compared with five patients in the alanine group. Three patients (17 percent) had major partial flap loss and were all in the alanine group; however, this was not significant (Fisher's exact test, P=0.15). These patients required surgical intervention with debridement and/or reduction in the reconstructed breast to close the defect and achieve a good aesthetic outcome. Four patients (22 percent) had minor partial flap loss. This was distributed evenly in both groups. These patients were treated conservatively without adverse outcome. If necessary, scars were corrected during standard second‐stage revision. Table 6.3 Flap complications. Flap complications All patients Arginine Alanine P‐value (N=18) (N=8) (N=10) All complications # 7 (30%) 2 (25%) 5 (50%) 0,28 Major PFL # 3 (17%) 0 (0%) 3 (30%) 0,09 Minor PFL # 4 (22%) 2 (25%) 2 (20%) 0,84 No complications # 11 (61%) 6 (75%) 5 (50%) 0,28 # Chi‐square test (2‐tailed) The concentration of arginine and alanine remained statistically higher in their corresponding groups (Figures 6.4 and 6.5). The arginine metabolites were also higher in the arginine group compared with the alanine group. No significant differences were detected in the hemodynamics (mean arterial pressure and heart rate) and flap temperature during the first 24 hours when comparing the study groups. In zone I, there was no difference in blood flow between the arginine group and the placebo group. As described previously, laser Doppler flowmetry demonstrated different flow trends in zone I compared with zone IV, indicating a delayed opening and/or vasodilatation of vessels connecting zone I and zone IV of the flap.20 In the arginine group, zone IV had a higher (P=0.04) microcirculatory blood flow than the alanine control group (Figure 6.6). 92
Microsoft Word - chapter 0 v1 DB.doc
To see the actual publication please follow the link above