Document Detail

Importance of right subcostal incisions in patients undergoing TRAM flap breast reconstruction.
MedLine Citation:
PMID:  12187336     Owner:  NLM     Status:  MEDLINE    
The presence of a preexisting subcostal incision alters the approach to breast reconstruction and is thought to predispose to donor site skin complications and flap loss. The purpose of this study was to determine whether the presence of a subcostal scar affects breast or donor site morbidity adversely after transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction. Twenty-six patients with a right subcostal incision (group A) underwent TRAM flap breast reconstruction (13 immediate, 13 delayed). The average age was 51 years, and the patients had an average body mass index of 25.3. There were 15 right, 10 left, and 1 bilateral reconstruction (4 free flaps, 22 pedicled). Outcome measures were compared with 126 age- and risk-matched patients (group B) who underwent TRAM flap reconstruction without any preexisting abdominal scar. The average age in group B was 46.7 years, and the patients had an average body mass index of 24.8. The average length of stay in group A was 5.9 days, compared with 4.8 days in group B ( < 0.05). There were no significant differences in breast-related complications. Donor site complications were higher in group A, with abdominal wall skin necrosis being significantly higher in patients with a subcostal incision (25%) compared with those patients without abdominal wall scars (5%; = 0.02). Multivariate analysis revealed a 6.5-fold increase in donor site complications in patients with a subcostal incision and a smoking history ( < 0.05). When adjusted for radiation treatment, the increased incidence in donor site complication rate was only marginally significant ( = 0.08). TRAM flap breast reconstruction in patients with preexisting right subcostal scars is effective with certain technical modifications; however, there is a slight predisposition to increased abdominal wall complications. Smoking influenced outcome further in patients with a subcostal incision, stressing the importance of proper patient selection.
Albert Losken; Grant W Carlson; Glyn E Jones; John H Culbertson; Mark Schoemann; John Bostwick
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of plastic surgery     Volume:  49     ISSN:  0148-7043     ISO Abbreviation:  Ann Plast Surg     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-08-20     Completed Date:  2002-11-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7805336     Medline TA:  Ann Plast Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  115-9     Citation Subset:  IM    
Division of Plastic and Reconstructive Suurgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
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MeSH Terms
Breast / surgery
Cicatrix / complications*
Ischemia / etiology*
Mammaplasty / adverse effects*
Middle Aged
Rectus Abdominis / blood supply*,  transplantation*
Retrospective Studies
Risk Factors
Surgical Flaps / adverse effects*,  blood supply*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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