Predicting and Managing Donor-Site Wound Complications in Abdominally Based Free Flap Breast Reconstruction: Improved Outcomes with Early Reoperative Closure

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Abstract

Background:

The purpose of this study was to (1) determine risk factors predictive of delayed abdominal healing; (2) determine characteristics that perpetuate progression to chronic abdominal wounds and describe the resultant morbidity; and (3) identify outcomes and cost following two treatment strategies—conservative wound care and early reoperative primary closure.

Methods:

Patients were identified from a database of abdominally based free flaps performed from January of 2005 through July of 2012.

Results:

One thousand two hundred eighteen abdominal donor sites were reviewed, and 167 cases (13.7 percent) of delayed abdominal wound healing were identified. Obesity (p < 0.0001), smoking (p = 0.043), bilateral reconstruction (p = 0.006), preoperative chemotherapy (p = 0.006), and abdominal mesh (p = 0.028) were independently associated with delayed healing. Initiation of chemotherapy p < 0.0001), wet-to-dry wound care (p = 0.001), negative-pressure wound therapy (p = 0.002), and flap type (p = 0.047) were predictive of chronic wounds, and such wounds generated higher rates of hospital readmission (p = 0.009), mesh complications (p < 0.001), and hernia/bulge (p = 0.006). Patients who underwent delayed primary wound closure were more likely to have a well-healed abdomen within 1 month (90.9 percent versus 24.2 percent; p < 0.0001), resulting in lower cost, fewer hospital readmissions, lower rates of scar revision, and lower rates of mesh complications/hernia/bulge.

Conclusions:

Chronic abdominal wounds were associated with abdominal wall sequelae, including hernia. Early reoperative primary wound closure has been successfully and selectively implemented, resulting in improved patient outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.

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