Cold ischemia in microvascular breast reconstruction.
BACKGROUND
A major drawback to microvascular free flap breast reconstruction is the length of operation-up to 9 hours or more for bilateral reconstruction. This takes a significant mental and physical toll on the surgical team, producing fatigue that may compromise surgical outcome. To facilitate the operation we have incorporated a period of cold ischemia of the flaps such that members of the surgical team can alternate a brief respite during the operation.


METHODS
We retrospectively reviewed our series of microvascular free flap breast reconstructions performed over a four-year period in which cold ischemia of the flaps were induced.


RESULTS
Seventy patients underwent free flap breast reconstruction with 104 flaps. Mean cold ischemia time for all flaps was 2 hours 36 min. Average rest time per surgeon per case was 35 min. Complications included two total flap losses (1.9%), one partial flap loss (1.0%), one anastomotic thrombosis (1.0%), two hematomas (1.9%), three fat necrosis (2.9%), and two delayed healing (1.9%). Statistical analysis revealed that the probability of complications is inversely related to cold ischemia time (P = 0.0163).


CONCLUSIONS
Cold ischemia facilitates breast reconstruction by allowing the surgical team to alternate breaks during the operation. This helps reduce surgeon fatigue and is well tolerated by the flap. Thus, we believe that the use of cold ischemia is safe and advantageous in microvascular breast reconstruction.
Lee
David T
DT
Stanford Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA 94304-5715, USA.
Lee
Gordon
G
D015331:Cohort Studies; D050377:Cold Ischemia / Q000009:adverse effects*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D008866:Microsurgery / Q000009:adverse effects*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing