Abstract
Background There is a growing trend across health care to perform increasingly complex procedures
in less acute settings. This shift has been fueled, in part, by enhanced recovery
protocols, which have shortened hospital stays after major surgeries. We set out to
determine the timing of microvascular complications after deep inferior epigastric
artery perforator (DIEP) free flap breast reconstruction in a high-volume practice
using continuous flap monitoring technologies.
Methods The medical charts of all patients who underwent breast reconstruction with DIEP
flaps over 24 consecutive months were reviewed. Postoperatively, all flaps were monitored
according to a protocol that included continuous tissue oximetry with near-infrared
spectroscopy. The primary end points evaluated included any unplanned return to the
operating room, time to takeback, and flap loss rate.
Results A total of 196 patients underwent breast reconstruction with a total of 301 DIEP
flaps. Five of the flaps (1.7%) were taken back to the operating room for microvascular
issues, and nine (3.0%) were taken back for nonvascular issues. Of patients who were
brought back for microvascular issues, all five (100.0%) were initially identified
by continuous noninvasive monitoring and taken back to the operating room within the
first 14 hours (range: 1.2–13.6 hours). In the series, the flap failure rate was 0.66%
(n = 2).
Conclusion All of the microvascular issues were detected in the initial 23 hours after surgery,
leading to prompt flap salvage. The results of this study bring into question the
need for lengthy flap monitoring protocols and suggest that shorter inpatient, or
even observation admissions, may be reasonable, particularly when flap monitoring
protocols incorporating continuous noninvasive flap monitoring are used.
Keywords
flap monitoring - breast reconstruction - tissue oximetry
