کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
4293755 1612310 2008 8 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Autologous Breast Reconstruction: The Vanderbilt Experience (1998 to 2005) of Independent Predictors of Displeasing Outcomes
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی عمل جراحی
پیش نمایش صفحه اول مقاله
Autologous Breast Reconstruction: The Vanderbilt Experience (1998 to 2005) of Independent Predictors of Displeasing Outcomes
چکیده انگلیسی

BackgroundOptimal surgical outcomes are dependent on an appreciation of comorbid conditions that may handicap results. The purpose of this retrospective analysis was to delineate risk factors for complications after autologous breast reconstruction.Study DesignAn institutional database was constructed of patients who underwent autologous breast reconstruction from 1998 to 2005. Variables captured included age, diabetes and smoking status, prereconstruction radiation therapy, concomitant breast resection, preoperative albumin, flap type, and body mass index (BMI; based on World Health Organization classifications: BMI > 25, overweight; > 30, obese). The primary outcome was noninfectious wound complications (NIWC), a novel classification based on the extent of tissue derangement and need for operative intervention. Secondary outcomes were wound infection, hematoma, hernia, and fat necrosis. Statistical analysis was performed using chi-square tests and multiple logistic regression.ResultsThe analysis included 200 flaps (transverse rectus abdominis myocutaneous [TRAM] = 171; latissimus dorsi = 29) in 180 patients. There were 19 infections (9.5%), 3 total flap losses (1.5%), 14 hematomas (7%), and 11 donor-site hernias (6%). The incidences of fat necrosis and any NIWC were 18% and 36%, respectively. Mean followup was 13.1 months (range 1.1 to 51.7 months). Multiple logistic regression demonstrated that obesity (BMI > 30) is a statistically significant independent risk factor for any NIWC (hazards ratio = 6.58; 95% CI, 2.85 to 15.18; p < 0.01) and for NIWC requiring operative treatment (NIWC ≥ 3; hazard ratio = 6.23; 95% CI 2.15 to 18.05; p < 0.01). Increased BMI predicts NIWC, NIWC requiring operative intervention, and wound infection (p < 0.01).ConclusionsThese data suggest that obesity is a strong predictor of simple and complex NIWC and of wound infection after autologous breast reconstruction. Obese patients should be counseled about their significantly increased risk of experiencing these unwanted outcomes.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of the American College of Surgeons - Volume 207, Issue 1, July 2008, Pages 49–56
نویسندگان
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