title: Development of a surgical algorithm and optimized management of complications - based on a review of 706 abdominal free flaps for breast reconstruction.
abstract: BACKGROUND
  Microsurgical free flaps are a common method of breast reconstruction. Our institutional experiences with 706 lower abdomen based free perforator flaps are reported with special interest in presenting a therapeutic algorithm for efficient decision-making.
  
  
  METHODS
  A retrospective chart review was performed. All patients undergoing free flap surgery for breast reconstruction between July 2004 and November 2009 were included.
  
  
  RESULTS
  Seven hundred and six free flaps were performed in 635 patients: 451 DIEAP-flaps, 254 fasciasparing (fs) TRAM-flaps and one SIEA flaps were performed. Five hundred sixty four women had a unilateral and 71 a bilateral reconstruction (142 flaps). The complication rate was 0.84% (6 flaps) for total flap loss, 1.27% (9 flaps) for partial flap loss and 2.40% (17 flaps) for partial flap loss less than 20%. 7 patients (1.11%) underwent microsurgical revision, where venous problems occurred. 3 of them were successful, in two cases a partial flap loss less than 30% occurred after the revision. In 2 cases a complete flap loss appeared. Other minor complications included: 23 patients (3.65%) had breast hematomas, 18 patients (2.54%) presented with delayed wound healing (9 abdominal and 9 breast delayed wound healings), and 3 patients (0.42%) with abdominal hernias, 14 patients (1.98%) complained of weakness of abdominal wall.
  
  
  CONCLUSIONS
  Abdominally based free flaps a safe and reliable method and should therefore be offered as a standard method in a breast cancer center. The protocol and algorithm presented here can reduce complications in microsurgical breast reconstructive surgery.
authors.affiliation: SANA Hospital Düsseldorf, Department of Plastic and Aesthetic Surgery, Breast Center Academic Center of Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Langer
authors.forename: Beatrix
authors.initials: B
authors.lastname: Munder
authors.forename: Katrin
authors.initials: K
authors.lastname: Seidenstuecker
authors.forename: Philipp
authors.initials: P
authors.lastname: Richrath
authors.forename: Philipp
authors.initials: P
authors.lastname: Behrendt
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kneser
authors.forename: Raymund E
authors.initials: RE
authors.lastname: Horch
authors.forename: Brian T
authors.initials: BT
authors.lastname: Andrews
authors.forename: Christoph
authors.initials: C
authors.lastname: Andree
mesh_terms: D000465:Algorithms; D001941:Breast Diseases / Q000601:surgery*; D003657:Decision Making; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing