Floor plan - 2013 Annual Meeting - American Association for Hand ...

Comparison Of Superior Gluteal Artery Perforator Flaps and Myocutaneous Flaps For Breast
Reconstruction
Institution where the work was prepared: University of California at Los Angeles, Los Angeles, CA, USA
Mark Gelfand, MD; Brian Boyd, MD; William Shaw, MD; James Watson, MD; Andrew Da Lio, MD; University California
Los Angeles
Use of the Superior Gluteal Artery (SGA) myocutaneous flap for breast reconstruction was popularized in the US by Shaw in 1983. At
UCLA it was initially the main backup in patients who were not candidates for autologous lower abdominal tissue flaps. Later it was
replaced by Superior Gluteal Artery Perforator flap (SGAP). This flap, first introduced by Allen and Tucker in 1995, allowed for a much
longer pedicle, leading to a simpler microvascular anastomosis, and obviated the need for vein grafts to access the internal mammary
vessels. However, so far there has been no head to head comparison of these two flaps. We performed retrospective chart review of
102 operations in 80 patients. A total of 70 SGA and 32 SGAP flaps were performed over a ten year period. Patients in SGAP group
tended to lose significantly less blood (241 vs. 375 cc) and were less likely to require transfusion (9% vs. 11.4 %). There was no significant
difference in length of surgery (505 min vs. 496 min) or hospital stay (4.4 vs. 4.7 days). Although the overall complication rate was
higher in SGAP group (28% vs. 20%), it failed to achieve statistical significance. Even though the difference in the rate of anastomotic
thrombosis (6 % in SGAP group vs 10 % in SGA group) was not statistically significant, patients in SGA group were prone to thrombosis
at venous site. They were also more likely to require vein grafting and require take-back for anastomotic problems, specifically venous
thrombosis. In this group, venous access proved a problem in number of cases even when a vein graft was not required: the external
jugular vein was utilized in 13 cases and the cephalic in 3. Overall, patients in SGAP group had higher rate of utilization of internal mammary
vessels for recipient site (100 % vs 66%), a statistically significant difference. To analyze requirements for second stage reconstruction
separate analysis was carried out for staged bilateral or unilateral breast reconstruction. There was no difference between two
groups with regards to a number of second stage operations, as well as number of procedures required to achieve optimal outcome
at donor site or breast. We believe that our report highlights that SGAP and SGA flaps are very similar. However, SGAP flap appears to
be superior in allowing utilization of internal mammary vessels for as recipients, allowing for better planned, smoother and more predictable
operative course.
Advanced Age as a Risk Factor for Free Tissue Transfer Breast Reconstructions: A Review of
372 Operations
Institution where the work was prepared: UCLA (University of California, Los Angeles), Los Angeles, CA, USA
Maura Reinblatt, MD; Luis Vaca; Jaco Festekjian, MD; James Watson, MD; Andrew Da Lio, MD; Christopher Crisera,
MD; University of California, Los Angeles
BACKGROUND:
Aging is an important risk factor for developing breast cancer. As the population ages, surgeons will encounter a growing proportion
of elderly women requiring breast reconstruction after mastectomy. Because free tissue transfer breast reconstruction generally results
in longer operative times and recovery periods, the applicability of microsurgical reconstruction in the aging patient needs further study.
We set out to assess the risks of microvascular breast reconstruction with advancing age.
METHODS:
A prospectively maintained database was utilized to identify microvascular breast reconstructions performed between 2002 and 2006.
Patients were divided into four age groups: less than 50 years of age (Group 1), between 50 and 59 (Group 2), between 60 and 69 (Group
3), and 70 years of age and above (Group 4). Comorbidities (hypothyroidism, diabetes, smoking, hypertension, hypercholesterolemia,
surgical history, body mass index), American Society of Anesthesiology (ASA) status, and length of hospital stay (LOS) were examined.
Surgical complications including flap loss, thrombosis, hematoma, abdominal hernia, and fat necrosis were analyzed.
RESULTS:
A total of 372 free flaps were performed on 295 patients, ranging from 24 to 75 (mean 51) years of age. The flap success rate was 99.2%,
with 3 flap losses. 60% of the flaps performed were free transverse rectus abdominis musculocutaneous (TRAM) and muscle-sparing
free TRAM, 34% were deep inferior epigastric artery perforator (DIEP), and 5% were superior gluteal artery perforator (SGAP). The overall
rate of surgical complications was 33%. The most common complication was fat necrosis (21%), followed by abdominal laxity or hernia
(6%). Age was not predictive of any surgical complication. There was no significant difference in the risk of overall surgical complications,
or each individual complication, among the various age groups. ASA designation was the only significant predictor of overall
surgical morbidity (p=0.02), specifically associated with fat necrosis (p=0.001) and hematoma (p