gms | German Medical Science

44. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 18. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC)

12.09. - 14.09.2013, Münster

Venous Coupler Size in Autologous Breast Reconstruction – Does it Matter?

Meeting Abstract

  • presenting/speaker Niclas Broer - Klinikum Bogenhausen/New York University, Abteilung Plastische Chirurgie/Plastic Surgery, München/New York, Deutschland/Vereinigte Staaten; New York University, Plastic Surgery, New York City, Vereinigte Staaten Von Amerika; Vereinigte Staaten Minor Outlying Islands
  • Katie Weichman - New York University, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
  • Neil Tanna - New York University, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
  • Jamie Levine - New York University, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
  • Steven Levine - New York University, Plastic Surgery, New York City, Vereinigte Staaten von Amerika
  • Robert Allen - New York University, Plastic Surgery, New York City, Vereinigte Staaten von Amerika

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 44. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 17. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Münster, 12.-14.09.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocFV 23

doi: 10.3205/13dgpraec030, urn:nbn:de:0183-13dgpraec0301

Veröffentlicht: 10. September 2013

© 2013 Broer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Autologous microvascular breast reconstruction has become an increasingly common reconstructive procedure. While the arterial anastomoses are traditionally being hand-sewn, the venous anastomoses are commonly completed with the aid of a coupler device. Whenever possible, the largest coupler size should be used which is determined, in cases of size miss-match, by the smaller of either the donor or recipient vein. While its efficacy has been shown using 3.0 mm size and greater couplers, little is known about the consequences of using coupler sizes less than or equal to 2.5 mm.

Methods: After obtaining an IRB waiver, a retrospective chart review of all patients undergoing autologous breast reconstruction was conducted at New York University Medical Center between November 2007 and November 2011. Flaps were divided into cohorts based on coupler size used: 2.0 mm, 2.5 mm, and 3.0 mm. Outcomes were measured by incidence of arterial insufficiency, venous insufficiency, hematoma, fat necrosis, partial flap loss, full flap loss, and need for future fat grafting.

Results: One-hundred ninety-seven patients underwent 392 flaps during the study period. Patients were similar in age, type of flap, smoking status, and radiation history. Coupler size less than or equal to 2.0 mm was found to be a significant risk factor for venous insufficiency (p=.038; risk reduction with coupler size greater than or equal to 2.5 mm 87%) as well as for development of fat necrosis (p=.041; 73% risk reduction) and future need for fat grafting (p=.050; 45% risk reduction). Interestingly, in multivariate analysis, BMI was found to be an independent risk factor for skin flap necrosis (p=.010) and full flap loss (p=.035).

Conclusions: Postoperative complications are significantly increased in patients requiring the use of 2.0 mm venous couplers and therefore it should be avoided whenever possible. Vessel modification including beveling or fish-mouthing, as well as more aggressive vessel exposure through rib harvest should be considered. Additionally, the use of thoracodorsal vessels or hand-sewn anastomosis should be considered in cases of internal mammary vein caliber of 2.0 mm or less.

Clinical Question: Therapeutic

Level of Evidence: Level III