title: Incidence and significance of microscopic pathological lesions found in pedicle and recipient vessels used in microsurgical breast reconstruction.
abstract: The purpose of this study was to assess the incidence of abnormal vascular histology and to determine whether or not this was correlated with the incidence of postoperative microvascular problems. The microvascular histology of both donor and recipient vessels was studied in 38 patients (40 flaps) undergoing breast reconstruction with free TRAM flaps. Preoperative risk factors were assessed and correlated with histological changes in vessels, and both were tested against anastomotic complications. Thrombosis of either the artery or the vein of the flap was seen in 6 cases (15%), and of these, two flaps failed completely and one suffered partial necrosis. The occlusion affected the arterial anastomosis in 3 patients, and the venous anastomosis in 2 patients, while both the artery and the vein were thrombosed in one case. Preoperative risk factors such as smoking, obesity, radiotherapy, and chemotherapy were not associated with a significantly higher incidence of thrombosis or with significant histological abnormalities in vessels (P value varied between 0.3-0.06). Microvascular histology showed variable degrees of pathological changes in six flaps (15%); nevertheless, in this group, only one flap suffered a venous thrombosis, which ended in total flap loss. Among those with one or more risk factors (24 patients), only 2 had some evidence of histological abnormality of the blood vessels used for the microvascular anastomosis (P = 0.2).
authors.affiliation: Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. Hamdyelmrakby@hotmail.com
authors.forename: H H
authors.initials: HH
authors.lastname: El-Mrakby
authors.forename: N R
authors.initials: NR
authors.lastname: McLean
authors.forename: P D
authors.initials: PD
authors.lastname: Hodgkinson
authors.forename: J V
authors.initials: JV
authors.lastname: Soames
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008833:Microcirculation / Q000473:pathology* / Q000502:physiology; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D013524:Surgical Flaps / Q000098:blood supply*; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology