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25-09-2024 | Mastectomy | Original Articles

Complications in Prolonged Intraoperative Ischemia Time in Free Flap Breast Reconstruction: A Systematic Review and Meta-Analysis

Authors: José Antonio Arellano, Alexander J Comerci, Hilary Y Liu, Mario Alessandri Bonetti, Vu T Nguyen, Brodie Parent, Elizabeth A Bailey, Andrea A Moreira, Michael L Gimbel, Francesco M Egro

Published in: Aesthetic Plastic Surgery

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Abstract

Background

Autologous tissue transfer is an effective option for breast reconstruction post-mastectomy, with microsurgical techniques continually evolving. However, a comprehensive analysis of the relationship between prolonged ischemia time during free flap-based breast reconstruction and increased postoperative complications is still lacking.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. Methodological quality was evaluated using the MINORS criteria. Studies meeting inclusion criteria were analyzed for total complications, complete and partial flap loss, and secondary outcomes. Data heterogeneity and risk ratios were assessed.

Results

Seventeen studies encompassing 5636 patients and 6884 free flaps were included. The mean age of patients was 49.43 years (95% CI: 48.27–50.60), with a mean BMI of 26.09 (95% CI: 21.97–30.21), and an average post-harvesting free flap ischemia time of 70.35 min (95% CI: 56.71–83.98). These analyses revealed a heightened risk of total complications (RR: 1.99, 95% CI: 1.61–2.46), complete flap loss (RR: 3.15, 95% CI: 1.32–7.52), partial flap loss (RR: 1.91, 95% CI: 0.92–4.00), hematoma (RR: 1.79, 95% CI: 0.96–3.32), and infection (RR: 2.12, 95% CI: 1.32–3.42) in cases with ischemia time exceeding 60 min. Venous complications predominated in free flap failure cases.

Conclusions

Effectively managing ischemia time could be crucial in free flap breast reconstruction to potentially reduce postoperative complications. Although there is a correlation between managing ischemia time and reducing postoperative complications, further research is needed to investigate the possible causation behind this relationship.

Level of Evidence I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.​springer.​com/​00266.
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Literature
Metadata
Title
Complications in Prolonged Intraoperative Ischemia Time in Free Flap Breast Reconstruction: A Systematic Review and Meta-Analysis
Authors
José Antonio Arellano
Alexander J Comerci
Hilary Y Liu
Mario Alessandri Bonetti
Vu T Nguyen
Brodie Parent
Elizabeth A Bailey
Andrea A Moreira
Michael L Gimbel
Francesco M Egro
Publication date
25-09-2024
Publisher
Springer US
Published in
Aesthetic Plastic Surgery
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-024-04382-7