Bilateral Simultaneous Lumbar Artery Perforator Flaps in Breast Reconstruction: Perioperative Outcomes Addressing Safety and Feasibility.
Abstract
[BACKGROUND] The lumbar artery perforator (LAP) flap has emerged as an excellent option for breast reconstruction, but its steep learning curve makes it less approachable. Furthermore, length of the operation, flap ischemia time, need for composite vascular grafts, complex microsurgery, multiple position changes, and general concern for safety has led experienced surgeons to stage bilateral reconstructions. In the authors' experience, simultaneous bilateral LAP flaps are feasible, but overall perioperative safety has not been fully explored.
[METHODS] Thirty-one patients (62 flaps) underwent simultaneous bilateral LAP flaps and were included in the study (excluding stacked four-flaps and unilateral flaps). Patients underwent two position changes in the operating room: supine to prone and then supine again. A retrospective review of patient demographics, intraoperative details, and complications was performed.
[RESULTS] The overall flap success rate was 96.8%. Five flaps were compromised postoperatively. The intraoperative anastomotic revision rate was 24.1% per flap (4.3% per anastomosis). The significant complication rate was 22.6%. The number of sustained hypothermic episodes and hypotensive episodes correlated with intraoperative arterial thrombosis ( P < 0.05). The number of hypotensive episodes and increased intraoperative fluid correlated with flap compromise ( P < 0.05). High body mass index correlated with overall complications ( P < 0.05). The presence of diabetes correlated with intraoperative arterial thrombosis ( P < 0.05).
[CONCLUSIONS] Simultaneous bilateral LAP flaps can be performed safely with an experienced and trained microsurgical team. Hypothermia and hypotension negatively affect the initial anastomotic success. In this complex operation, a coordinated approach between the anesthesia and nursing team is paramount for patient safety.
[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, IV.
[METHODS] Thirty-one patients (62 flaps) underwent simultaneous bilateral LAP flaps and were included in the study (excluding stacked four-flaps and unilateral flaps). Patients underwent two position changes in the operating room: supine to prone and then supine again. A retrospective review of patient demographics, intraoperative details, and complications was performed.
[RESULTS] The overall flap success rate was 96.8%. Five flaps were compromised postoperatively. The intraoperative anastomotic revision rate was 24.1% per flap (4.3% per anastomosis). The significant complication rate was 22.6%. The number of sustained hypothermic episodes and hypotensive episodes correlated with intraoperative arterial thrombosis ( P < 0.05). The number of hypotensive episodes and increased intraoperative fluid correlated with flap compromise ( P < 0.05). High body mass index correlated with overall complications ( P < 0.05). The presence of diabetes correlated with intraoperative arterial thrombosis ( P < 0.05).
[CONCLUSIONS] Simultaneous bilateral LAP flaps can be performed safely with an experienced and trained microsurgical team. Hypothermia and hypotension negatively affect the initial anastomotic success. In this complex operation, a coordinated approach between the anesthesia and nursing team is paramount for patient safety.
[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, IV.
추출된 의학 개체 (NER)
| 유형 | 영어 표현 | 한국어 / 풀이 | UMLS CUI | 출처 | 등장 |
|---|---|---|---|---|---|
| 시술 | flap
|
피판재건술 | dict | 5 | |
| 해부 | breast
|
유방 | dict | 2 | |
| 시술 | microsurgery
|
미세수술 | dict | 1 | |
| 해부 | vascular grafts
|
scispacy | 1 | ||
| 해부 | flaps
|
scispacy | 1 | ||
| 약물 | [BACKGROUND] The
|
scispacy | 1 | ||
| 질환 | ischemia
|
C0022116
Ischemia
|
scispacy | 1 | |
| 질환 | intraoperative anastomotic revision rate was 24.1% per flap (4.3% per anastomosis)
|
scispacy | 1 | ||
| 질환 | hypotensive
|
C0857353
Hypotensive
|
scispacy | 1 | |
| 질환 | intraoperative arterial thrombosis
|
scispacy | 1 | ||
| 질환 | diabetes
|
C0011847
Diabetes
|
scispacy | 1 | |
| 질환 | Hypothermia
|
C0020672
Hypothermia, natural
|
scispacy | 1 | |
| 질환 | hypotension
|
C0020649
Hypotension
|
scispacy | 1 | |
| 기타 | bilateral LAP flaps
|
scispacy | 1 | ||
| 기타 | four-flaps
|
scispacy | 1 | ||
| 기타 | arterial
|
scispacy | 1 |
MeSH Terms
Humans; Female; Perforator Flap; Mammaplasty; Retrospective Studies; Middle Aged; Feasibility Studies; Adult; Postoperative Complications; Treatment Outcome; Breast Neoplasms; Lumbosacral Region; Arteries; Aged; Patient Positioning
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같은 제1저자의 인용 많은 논문 (5)
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