Predictors of Complications in Autologous Breast Reconstruction Using DIEP Flaps: Implications for Management
Research article published in Plastic and reconstructive surgery (2023)
Abstract
BACKGROUND: Deep inferior epigastric perforator (DIEP) flaps are the standard for autologous breast reconstruction. This study investigated risk factors for DIEP complications in a large, contemporary cohort to optimize surgical evaluation and planning. METHODS: This retrospective study included patients who underwent DIEP breast reconstruction between 2016 and 2020 at an academic institution. Demographics, treatment, and outcomes were evaluated in univariable and multivariable regression models for postoperative complications. RESULTS: In total, 802 DIEP flaps were performed in 524 patients (mean age, 51.2 ± 9.6 years; mean body mass index, 29.3 ± 4.5). Most patients (87%) had breast cancer; 15% were BRCA -positive. There were 282 (53%) delayed and 242 (46%) immediate reconstructions and 278 (53%) bilateral and 246 (47%) unilateral reconstructions. Overall complications occurred in 81 patients (15.5%), including venous congestion (3.4%), breast hematoma (3.6%), infection (3.6%), partial flap loss (3.2%), total flap loss (2.3%), and arterial thrombosis (1.3%). Longer operative time was significantly associated with bilateral immediate reconstructions and higher body mass index. Prolonged operative time (OR, 1.16; P = 0.001) and immediate reconstruction (OR, 1.92; P = 0.013) were significant predictors of overall complications. Partial flap loss was associated with bilateral immediate reconstructions, higher body mass index, current smoking status, and longer operative time. CONCLUSIONS: Prolonged operative time is a significant risk factor for overall complications and partial flap loss in DIEP breast reconstruction. For each additional hour of surgical time, the risk of developing overall complications increases by 16%. These findings suggest that reducing operative time through co-surgeon approaches, consistency in surgical teams, and counseling patients with more risk factors toward delayed reconstructions may mitigate complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This retrospective study of 802 DIEP flaps in 524 patients identified predictors of complications in autologous breast reconstruction, finding that prolonged operative time (OR 1.16; ~16% added risk per extra hour) and immediate reconstruction (OR 1.92) independently predicted overall complications, and reported venous congestion in 3.4% of flaps among an overall 15.5% complication rate. For ASH this matters because venous congestion is the specific flap-salvage scenario in which medicinal leeches are clinically used, and the paper quantifies how often congestion and flap loss arise in modern DIEP reconstruction, framing the population that leech therapy may serve. Honest caveat: this is a single-institution retrospective cohort about surgical risk factors and timing; it does not study or mention leech therapy, so it bounds the clinical problem rather than providing any evidence for hirudotherapy itself.
Citation
Predictors of Complications in Autologous Breast Reconstruction Using DIEP Flaps: Implications for Management.
Wu et al. · Plastic and reconstructive surgery, 2023
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