Serious complications and salvage methods in breast reconstruction with free flap transplantation
10.3760/cma.j.issn.1671-0290.2024.04.013
- VernacularTitle:游离皮瓣移植乳房再造的严重并发症及补救措施
- Author:
Youxi WANG
1
;
Xu LIU
;
Zhiyuan WANG
;
Dajiang SONG
;
Zan LI
Author Information
1. 陕西省人民医院肿瘤外科，西安 710068
- Keywords:
Mammaplasty;
Postoperative complications;
Flap failure;
Free flap;
Breast reconstruction;
Salvage
- From:
Chinese Journal of Medical Aesthetics and Cosmetology
2024;30(4):359-364
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the serious complications and salvage methods and experience of breast reconstruction with free flap transplantation.Methods:Different techniques of free flap transplantation were used for breast reconstruction in 395 breast cancer patients who came to Hunan Cancer Hospital from September 2015 to December 2021. 45 complications occurred during and after surgery, including 21 serious complications. Corresponding salvage method was used for complications and flap failure. Salvage methods included free gracilis myocutaneous flap combined with adductor magnus perforator flap, free adductor magnus perforator flap transplantation, pedicled rectus abdominis flap transplantation, pedicled latissimus dorsi myocutaneous flap, prosthetic replacement, vascular grafting, vascular reanastomosis and release of vascular tension area.Results:The specific causes and salvage methods in 21 cases of reoperation included: 3 cases of excessive tension or compression of vascular pedicle, of which 1 case was successfully salvaged; in 2 cases flap failure was occurred, of which 1 case was replaced with prosthesis, and 1 case was salvaged with free gracilis myocutaneous flap combined with adductor magnus perforator flap; one case of vascular embolism caused by poor quality of vascular anastomosis was successfully salveged by vascular re anastomosis. One case had poor recipient vessels, and the flap failure was salvaged with pedicled latissimus dorsi flap. Three patients had poor compliance, of which one case was successfully salvaged, and the other two cases had total flap failure, which were repaired by free adductor magnus perforator flap and free gracilis myocutaneous flap combined with adductor magnus perforator flap respectively. Two patients had menstrual postoperatively, resulting in flap failure. Free gracilis myocutaneous flap combined with adductor magnus perforator flap and free adductor magnus perforator flap were used for breast reconstruction respectively. In 1 case, the blood supply was affected by excessive flap trimming, and the flap failure was salvaged by free adductor magnus perforator flap. 10 cases of subcutaneous hematoma were treated with debridement and exploration, and all were successfully salvaged.Conclusions:The complications and failure of free flap for breast reconstruction cannot be completely avoided. It is very important to master the corresponding salvage methods.
