Predictors of Complications in Autologous Breast Reconstruction Using DIEP Flaps: Implications for Management
Research article published in Plastic and reconstructive surgery (2023)
Resumen
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.
Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.
El resumen se deja sin traducir para conservar la redacción original de los autores.
Síntesis
In 802 DIEP flaps in 524 patients, overall complications occurred in 15.5%, including venous congestion and flap loss; prolonged operative time and immediate reconstruction independently predicted complications, with each added surgical hour raising risk by 16%.
Por qué esto importa para la hirudoterapia
Este estudio retrospectivo de 802 colgajos DIEP en 524 pacientes identificó predictores de complicaciones en la reconstrucción mamaria autóloga, encontrando que el tiempo operatorio prolongado (OR 1.16; ~16% de riesgo añadido por cada hora extra) y la reconstrucción inmediata (OR 1.92) predijeron de forma independiente las complicaciones generales, y reportó congestión venosa en el 3.4% de los colgajos dentro de una tasa de complicaciones general del 15.5%. Para la ASH esto es importante porque la congestión venosa es el escenario específico de rescate de colgajo en el que se usan clínicamente las sanguijuelas medicinales, y el artículo cuantifica con qué frecuencia surgen la congestión y la pérdida de colgajo en la reconstrucción DIEP moderna, enmarcando la población a la que puede servir la terapia con sanguijuelas. Advertencia honesta: esta es una cohorte retrospectiva de una sola institución sobre factores de riesgo quirúrgicos y el momento de la cirugía; no estudia ni menciona la terapia con sanguijuelas, por lo que delimita el problema clínico en lugar de proporcionar alguna evidencia para la hirudoterapia en sí.
Citación
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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Añadido a la biblioteca ASH: 28 de mayo de 2026 · Última actualización del sitio: 18 de junio de 2026