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J Reconstr Microsurg
DOI: 10.1055/a-2616-4598
Original Article

Impact of Judicious Fluid Administration in the Setting of Abdominally Based Free Flaps

Lyndsay A. Kandi
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago, Illinois
,
Nicole Van Spronsen
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic in Arizona, Phoenix, Arizona
,
W. Nicholas Jungbauer  Jr
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic in Arizona, Phoenix, Arizona
,
Jaime Sexton
3   Department of General Surgery, University of Connecticut, Farmington, Connecticut
,
Nellie Movtchan
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic in Arizona, Phoenix, Arizona
,
Yu-Hui Chang
4   Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
,
Edward Reece
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic in Arizona, Phoenix, Arizona
,
Alanna M. Rebecca
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic in Arizona, Phoenix, Arizona
,
William J. Casey III
2   Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic in Arizona, Phoenix, Arizona
› Author Affiliations
Funding None.
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Abstract

Background

Abdominally based free flaps are commonly utilized in the context of breast reconstruction. Historically, postoperative care of these patients involved liberal amounts of intravenous fluid administration; however, overadministration of fluids puts patients at risk of developing flap edema via fluid shifts, electrolyte imbalances, wound dehiscence, and other sequelae. The purpose of this study is to assess fluid administration trends in this cohort at the authors' institution and assess its impact on patient outcomes.

Methods

A retrospective review was performed on patients who underwent free-flap breast reconstruction. Patient demographics and hospitalization data were collected, and type of abdominal flap and reconstruction timing was noted. Perioperative fluid administration volumes were tracked, and primary outcomes included complication rate and type (e.g., acute blood loss anemia [ABLA], partial/total flap loss, etc.). Multivariable logistic regression was performed to assess the impact of fluid volume on patient outcomes.

Results

A total of 115 patients (mean age of 51.3 ± 10.5 years) underwent 188 abdominally based free flaps. Deep inferior epigastric artery perforator flaps were performed most often (n = 91), followed by muscle-sparing transverse rectus abdominis flaps (n = 88). Multivariable logistic regression demonstrated that high perioperative fluid administration (≥9,000 mL) was associated with increased odds of medical complications (odds ratio [OR] = 21.7; confidence interval [CI]: 5.54–84.5; p < 0.001). Patients with high fluid administration volumes experienced an increased (but nonstatistically significant) flap complication rate (OR = 2.96; CI: 0.89–9.88; p = 0.08) and developed ABLA at a higher rate (OR = 15.86; CI: 5.30–46.4; p < 0.001).

Conclusion

High-volume resuscitation (≥9,000 mL) was associated with increased odds of ABLA as well as a greater likelihood of medical and flap complications in patients undergoing abdominally based free flaps for breast reconstruction. These data should be used to guide the development of protocols within institutions, which perform free flaps for breast reconstruction.

Keywords

fluid administration - DIEP - free flap - ERAS


Publication History

Received: 19 December 2024

Accepted: 12 May 2025

Accepted Manuscript online:
20 May 2025

Article published online:
17 June 2025

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