Jacobi, Maximilian (2024) Different factor’s influence on complication rates in unilateral deep inferior epigastric perforator flap reconstruction. thesis, Medicine.
Full text available on request.Abstract
The Deep Inferior Epigastric Artery Perforator (DIEP) flap is the gold standard of autologous breast reconstructions The introduction of this time-consuming operation has resulted in shortage of operation room (OR) time. Patient demand has increased and simultaneously, novel patient groups such as asymptomatic young women with breast cancer mutations undergoing preventative mastectomies have risen. Decreasing the duration of the DIEP flap surgery is thus pertinent in facilitating this increased demand. Enhanced recovery after surgery (ERAS) and LEAN protocols have been set up to do just that. Previously, our department of plastic and reconstructive surgery has proposed such methods to reduce OR time. Others have shown that with a reduction in OR time there is also a reduction in complication rates. The cohort subject to this study is from a center that has many experienced microsurgeons which have been dedicated to increasing the efficiency of flaps surgery for years. The goal of this paper is to identify the patient-specific and operation-related factors that influence early (<30 days) and late (>30 days) complication rates, including operation time. Complications are classified as type ≥3 on the Clavien-Dindo scale (requiring re-operation) with special attention to (partial/complete) flap loss and skin necrosis (mammary and abdominal). This study is designed as a retrospective cohort analysis in a single center looking at all DIEP flaps performed from 2013-2019, with 100 patients meeting the inclusion criteria. Direct and delayed unilateral DIEP reconstructions were included with all patients having the indication post-mastectomy (primary breast cancer or risk-reduction). Patients that underwent different forms of breast reconstruction, including other flap types, were excluded. Predictors for postoperative complication rates were identified using logistic regression in case of continuous variables, such as operative time in minutes or age in years. Chi squared test was used in case of binary predictors, such as positive smoking status or presence of hypertension. None of the factors studied had an influence on the rate of early complications, including age, body mass index (BMI), smoking status, hypertension, diabetes mellitus, prior abdominal surgery, past radiotherapy, hormonal therapy and chemotherapy. For late complications, only prior abdominal surgery turned out to be a significant predictor. It should be noted that with a mean age of 51 and mean BMI of 27, there is some selection bias. Just a dozen of the patients had a BMI above 30, which many centers consider a hard cut-off for the exclusion from indication for DIEP flap. Operation time as a continuous variable failed to reach significance for both early and late complications. Splitting operation time into quartiles, similar to a paper by Shtarbanov et al., we did not find more complications with increasing quartiles. Six cases of flap loss were recorded, two total and four partial flap loss, all within 30 days of surgery. None of the aforementioned variables turned out to be a predictor for this type of complication. As only three patients experienced any form of (early and late) skin necrosis, no analysis with sufficient power was possible for this particular outcome but a brief description of each case is provided.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Rakhorst, Hinne |
| Faculty: | Medical Sciences |
| Date Deposited: | 22 Oct 2025 13:59 |
| Last Modified: | 22 Oct 2025 13:59 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3837 |
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