Management of postoperative microvascular compromise and ischemia reperfusion injury in breast reconstruction using autologous tissue transfer: Retrospective review of 2103 flaps Journal Article


Authors: Coriddi, M.; Myers, P.; Mehrara, B.; Nelson, J.; Cordeiro, P. G.; Disa, J.; Matros, E.; Dayan, J.; Allen, R.; McCarthy, C.
Article Title: Management of postoperative microvascular compromise and ischemia reperfusion injury in breast reconstruction using autologous tissue transfer: Retrospective review of 2103 flaps
Abstract: Background: Although rates of microvascular thrombosis following free-flap breast reconstruction are low, debate persists about the optimal methods to restore blood flow and prevent ensuing flap shrinkage or fibrosis. Here we evaluate our management of microvascular compromise, including both a review of our approach for restoring blood flow and addressing the ensuing inflammatory changes following ischemia reperfusion. Methods: We conducted a retrospective review of autologous free tissue transfer breast reconstructions from 1/2010 to 1/2020. Patients who had flaps requiring take-back for salvage were identified. Management of microvascular compromise and ischemia reperfusion injury were recorded. Results: Of 2103 flaps were used in the breast reconstructions, 47 flaps required take-back for microvascular compromise (2.2%). Most flaps were either completely salvaged (n = 29, 61.7%) or partially salvaged (n = 5, 10.6%). Thirteen (27.7%) were a total flap loss, for an overall rate of 0.8% (including 3 flaps with no salvage attempt). Management of microvascular compromise most often included revision of the anastomosis (n = 33, 70.2%), thrombectomy (n = 27, 57.4%), tissue plasminogen activator administration (n = 26, 55.3%), and vein grafts (n = 18, 38.3%). Management of ischemia reperfusion included intraoperative steroids (n = 33, 70.2%), postoperative steroids (n = 17, 38.6%), and postoperative therapeutic anticoagulation (n = 27, 61.3%). Of 34 salvaged flaps, 5 (14.7%) had partial flap loss and/or fat necrosis on clinical examination at an average follow-up of 2.7 ± 2.8 years. Conclusions: Salvage of microvascular compromise in autologous breast reconstruction should include restoration of blood flow and management of ischemia reperfusion injury. Attention to both is paramount for successful outcomes. © 2021 Wiley Periodicals LLC.
Keywords: retrospective studies; breast reconstruction; mammaplasty; retrospective study; postoperative complication; postoperative complications; free tissue graft; tissue plasminogen activator; reperfusion injury; adverse event; free tissue flaps; humans; human
Journal Title: Microsurgery
Volume: 42
Issue: 2
ISSN: 0738-1085
Publisher: Wiley Liss  
Date Published: 2022-02-01
Start Page: 109
End Page: 116
Language: English
DOI: 10.1002/micr.30845
PUBMED: 34854501
PROVIDER: scopus
PMCID: PMC8810672
DOI/URL:
Notes: Article -- Export Date: 1 March 2022 -- Source: Scopus
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MSK Authors
  1. Joseph Disa
    262 Disa
  2. Babak Mehrara
    445 Mehrara
  3. Peter G Cordeiro
    282 Cordeiro
  4. Evan Matros
    201 Matros
  5. Colleen Marie McCarthy
    143 McCarthy
  6. Joseph Henry Dayan
    100 Dayan
  7. Jonas Allan Nelson
    208 Nelson
  8. Michelle Renee Coriddi
    58 Coriddi