Browsing by Subject "Free Tissue Flaps"
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Item Analysis of Free Flap Breast Reconstruction Failures: Are Specific Patient Characteristics Associated with Free Flap Failure?(2013-01-22) Sciano, Natalie M.; Farkas, Jordan; Cortez, Robert; Miller, Travis; Davis, Kathryn; Kenkel, Jeffrey M.PURPOSE: This study was performed to gain insight on the patients who have undergone free flap breast reconstructive surgery. Recognizing certain patient variables, as risk factors for developing free flap failure, is invaluable. This knowledge can provide surgeons the benefit of foresight when assessing patients pre and postoperatively. The goal was to identify specific characteristics that predisposed patients to developing flap failure. METHODS: A retrospective chart review was completed on patients who had received free flap breast reconstructive surgery during January 2008 to January 2012. A cohort of 124 patients receiving free flap reconstruction was identified using the Current Procedural Technology (CPT) code 19364. A number of patient variables which include general characteristics, comorbidities, and surgical characteristics were analyzed to determine their contribution toward a patient's development of free flap failure. Patients were categorized into two groups- those without and those with flap failure. A comparison of the means and proportions was performed to determine statistical significance between the two groups. The level of statistical significance for this univariate analysis was set at a P < 0.05. RESULTS: All of the 124 patients identified were female. The overall flap success rate was 91.94 percent, with only ten patients experiencing flap failure. Of the factors analyzed in this study, there was not an identified patient characteristic that predisposed a patient to developing free flap failure. CONCLUSIONS: Flap failure is an unfortunate risk of reconstructive surgery that needs to be minimized at all costs. No specific patient variables were identified as predisposing risk factors that could contribute to free flap failure. Institutions should strive to educate all breast reconstruction candidates on their options and risks which can help increase the volume of patients acquiring reconstruction. In the future, other investigations with a larger sample size should be done to yield more beneficial information for the physician and patient.Item Co-Surgeons in Breast Reconstructive Microsurgery: What Do They Bring to the Table?(2019-03-18) Haddock, Nicholas T.; Kayfan, Samar; Pezeshk, Ronnie A.; Teotia, Sumeet S.; Kayfan, Samar; Teotia, Sumeet S.; Haddock, Nicholas T.; Rozen, ShaiINTRODUCTION: Current research within other surgical specialties suggests that a co-surgeon approach may reduce operative times and complications associated with complex bilateral procedures, possibly leading to improved patient and surgical outcomes. We sought to evaluate the role of the co-surgery team and its development in free flap breast reconstruction. METHODS: A retrospective review of free-flap breast reconstruction by two surgeons from 2011-2016 was conducted. We analyzed 128 patients who underwent bilateral-DIEP breast. Surgical groups were: single-surgeon reconstruction (SSR; 35 patients), Co-Surgery where both surgeons are present for entire reconstruction (CSR-I; 69 patients), and Co-Surgery reconstruction where co-surgeons appropriately assist in two concurrent or staggered cases (CSR-II; 24 patients). Efficiency data collected was OR time and patient length-of-stay (LOS). The rate of flap-failure, return to OR, infection, wound breakdown, seroma, hematoma and PE/DVT were compared. RESULTS: Single-surgeon reconstruction had significantly longer OR time (678 vs 485 minutes, p< 0.0001), LOS (5 vs 3.9 days, p<0.001), higher wound occurrences of the umbilical site that required surgical correction [11.4 percent (n=4) versus 1.5 percent,(n=1); p<0.043] compared to CSR-I. Similarly, SSR had significantly longer average OR time (678 vs 527 minutes p< 0.0001), average LOS (5 days vs 4 days, p=0.0005) when compared to CSR-II. There were no total increased patient related complications associated with co-surgery (CSR- I or II). CONCLUSION: The addition of a Co-surgeon, even with concurrent surgery, reduces operative time, average patient LOS, and post-operative complications. This work lends a strong credence that Co-surgery model is associated with increased operative efficiency.