P Gimbergues1, G Le Bouedec, C Pomel, M Janny-Peyronie, J Dauplat. 1. Service de chirurgie, unité de chirurgie oncologique (Pr J. Dauplat), centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 cedex 1, Clermont-Ferrand, France. pgimbergues@cjp.u-clermont1.fr <pgimbergues@cjp.u-clermont1.fr>
Abstract
OBJECTIVE: To evaluate, in our experience, the morbidity of the trans rectus abdominis musculocutaneous flap (TF), to determine the risks factors and the advantage of surgical delay procedure. PATIENTS AND METHODS: TF was used for 125 consecutive breast reconstructions. Thirty-eight patients (30,4%) had recidive after conservative treatment and 62 (49,6%) have been included in a procedure associating chemotherapy, radiation therapy and mastectomy with immediate breast reconstruction (IBR), 31 patients were obese (24,8%), 14 were smoker (11,2%), 118 (94,4%) had prior thoracic radiation, 97 (77,6%) had a surgical delay procedure by ligation of the inferior epigastric pedicle, 115 (92%) had IBR, 99 TF were unipediculed and 26 were bipediculed. RESULTS: Immediate morbidity was: 21 necrosis of the flap (16,8%) among 1 total necrosis (0,8%), 6 hematomas (4,8%). Secondary morbidity was: 14 fat necrosis (11,2%), 9 eventrations (7,2%), 6 hernias (4,8%). The only statistic factor founded for ischemic complication was obesity (P = 0,036). The abdominal repair with interposed mesh was the only factor who decreased significatively (P = 0,013) the wall complication rate. The surgical procedure delay did not reduce ischemic complication rate (P = 0,92). CONCLUSION: TF can be performed with an acceptable complication rate in institution who realise frequently breast reconstruction procedure. Surgical delay procedure in our experience must be reconsidered.
OBJECTIVE: To evaluate, in our experience, the morbidity of the trans rectus abdominis musculocutaneous flap (TF), to determine the risks factors and the advantage of surgical delay procedure. PATIENTS AND METHODS: TF was used for 125 consecutive breast reconstructions. Thirty-eight patients (30,4%) had recidive after conservative treatment and 62 (49,6%) have been included in a procedure associating chemotherapy, radiation therapy and mastectomy with immediate breast reconstruction (IBR), 31 patients were obese (24,8%), 14 were smoker (11,2%), 118 (94,4%) had prior thoracic radiation, 97 (77,6%) had a surgical delay procedure by ligation of the inferior epigastric pedicle, 115 (92%) had IBR, 99 TF were unipediculed and 26 were bipediculed. RESULTS: Immediate morbidity was: 21 necrosis of the flap (16,8%) among 1 total necrosis (0,8%), 6 hematomas (4,8%). Secondary morbidity was: 14 fat necrosis (11,2%), 9 eventrations (7,2%), 6 hernias (4,8%). The only statistic factor founded for ischemic complication was obesity (P = 0,036). The abdominal repair with interposed mesh was the only factor who decreased significatively (P = 0,013) the wall complication rate. The surgical procedure delay did not reduce ischemic complication rate (P = 0,92). CONCLUSION: TF can be performed with an acceptable complication rate in institution who realise frequently breast reconstruction procedure. Surgical delay procedure in our experience must be reconsidered.