title: Predicting and managing donor-site wound complications in abdominally based free flap breast reconstruction: improved outcomes with early reoperative closure.
abstract: BACKGROUND
  The purpose of this study was to (1) determine risk factors predictive of delayed abdominal healing; (2) determine characteristics that perpetuate progression to chronic abdominal wounds and describe the resultant morbidity; and (3) identify outcomes and cost following two treatment strategies-conservative wound care and early reoperative primary closure.
  
  
  METHODS
  Patients were identified from a database of abdominally based free flaps performed from January of 2005 through July of 2012.
  
  
  RESULTS
  One thousand two hundred eighteen abdominal donor sites were reviewed, and 167 cases (13.7 percent) of delayed abdominal wound healing were identified. Obesity (p < 0.0001), smoking (p = 0.043), bilateral reconstruction (p = 0.006), preoperative chemotherapy (p = 0.006), and abdominal mesh (p = 0.028) were independently associated with delayed healing. Initiation of chemotherapy p < 0.0001), wet-to-dry wound care (p = 0.001), negative-pressure wound therapy (p = 0.002), and flap type (p = 0.047) were predictive of chronic wounds, and such wounds generated higher rates of hospital readmission (p = 0.009), mesh complications (p < 0.001), and hernia/bulge (p = 0.006). Patients who underwent delayed primary wound closure were more likely to have a well-healed abdomen within 1 month (90.9 percent versus 24.2 percent; p < 0.0001), resulting in lower cost, fewer hospital readmissions, lower rates of scar revision, and lower rates of mesh complications/hernia/bulge.
  
  
  CONCLUSIONS
  Chronic abdominal wounds were associated with abdominal wall sequelae, including hernia. Early reoperative primary wound closure has been successfully and selectively implemented, resulting in improved patient outcomes.
  
  
  METHODS
  Risk, III.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, University of Pennsylvania Health System.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mirzabeigi
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Wilson
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Marten
authors.initials: M
authors.lastname: Basta
authors.forename: Suhail
authors.initials: S
authors.lastname: Kanchwala
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D058107:Abdominal Wound Closure Techniques; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence; D013997:Time Factors; D060053:Transplant Donor Site; D016896:Treatment Outcome; D014945:Wound Healing