Time-Dependent Factors in Diep Flap Breast Reconstruction
Fabio Santanelli di Pompeo, MD PhD1, Rosaria Laporta, MD PhD1, Benedetto Longo, MD PhD1, Michail Sorotos, MD2, Vittoria Amorosi, MD1.
1Azienda Ospedaliera Sant'Andrea, "Sapienza" University of Rome, Rome, Italy, 2Azienda Ospedaliera Sant'Andrea, "Sapienza" University of Rome, 00185, Italy.
PURPOSE: Total length of breast reconstruction with DIEP flap transfer, from skin-incision to closure, was recorded looking for the impact of the different variables on the operative-time (OT).
METHODS: Four-hundred-four unilateral reconstruction (336 immediate, 68 delayed) performed by a single surgeon between 2004 and 2016 were retrospectively analysed from a prospective data base. Age, weight, height, body mass index (BMI), nulliparity or pluriparity condition, flap weight, mastectomy type, flap angiosomes, number of perforators and of venous anastomoses, recipient vessels selection, reconstruction timing, contralateral symmetrization and a dedicated anesthesiologist were evaluated as possible predictors on OT. A p-value <0.05 was considered as significant.
RESULTS: Mean OT was 289-minute (range, 150-550 minutes). At univariate-analysis, for each increment of BMI-value and patient weight the OT increased respectively of 3.5- and 1.4-minute (p<0.001). Skin-sparing mastectomy (SSM) (p=0.025), number of perforator and of venous anastomoses (p<0.001) negatively influenced the OT while nipple-sparing-mastectomy (NSM) reduced the OT of 22.7-minute (p=0.012). Circumflex scapular vessels as recipient reduced the OT of 75.4-minute while the internal mammary vessels (IMV) increased the OT of 55.8-minute (p<0.001). Anesthesiologist and surgeon learning-curves reduced OT respectively of 39.63-minute and of 13-minute for every year (p<0.001). At multivariate-regression, surgeon learning-curve was a negative predictor while SSM, number of perforators, the superficial epigastric vein, IMV and flap weight were positive predictors (p<0.001).CONCLUSION: In DIEP flap surgery efficiency is optimized by LC meaning systematic approach for surgery, while the increase of flap weight, number of perforators and number of vein anastomosis negatively influence the OT.
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