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.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.

• Authors: Michael N Mirzabeigi, Anthony J Wilson, John P Fischer, Marten Basta, Suhail Kanchwala, Stephen J Kovach, Joseph M Serletti, Liza C Wu
• Journal: Plastic and reconstructive surgery (Plast Reconstr Surg) Vol. 135 Issue 1 Pg. 14-23 (Jan 2015) ISSN: 1529-4242 [Electronic] United States
• PMID: 25539292 (Publication Type: Journal Article)

Topics

• Abdominal Wound Closure Techniques
• Female
• Free Tissue Flaps
• Humans
• Mammaplasty (methods)
• Middle Aged
• Postoperative Complications (surgery)
• Prognosis
• Reoperation
• Retrospective Studies
• Risk Factors
• Surgical Wound Dehiscence
• Time Factors
• Transplant Donor Site
• Treatment Outcome
• Wound Healing