Complications in Prolonged Intraoperative Ischemia Time in Free Flap Breast Reconstruction: A Systematic Review and Meta-Analysis

José Antonio Arellano; Alexander J Comerci; Hilary Y Liu; Mario Alessandri Bonetti; Vu T Nguyen; Brodie Parent; Elizabeth A Bailey; Andrea A Moreira; Michael L Gimbel; Francesco M Egro

doi:10.1007/s00266-024-04382-7

Complications in Prolonged Intraoperative Ischemia Time in Free Flap Breast Reconstruction: A Systematic Review and Meta-Analysis

Aesthetic Plast Surg. 2024 Sep 25. doi: 10.1007/s00266-024-04382-7. Online ahead of print.

Affiliations

¹ Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA.
² Department of Plastic Surgery, University of Milan, Milan, Italy.
³ Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA. francescoegro@gmail.com.

PMID: 39322841
DOI: 10.1007/s00266-024-04382-7

Abstract

Background: Autologous tissue transfer is an effective option for breast reconstruction post-mastectomy, with microsurgical techniques continually evolving. However, a comprehensive analysis of the relationship between prolonged ischemia time during free flap-based breast reconstruction and increased postoperative complications is still lacking.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Methodological quality was evaluated using the MINORS criteria. Studies meeting inclusion criteria were analyzed for total complications, complete and partial flap loss, and secondary outcomes. Data heterogeneity and risk ratios were assessed.

Results: Seventeen studies encompassing 5636 patients and 6884 free flaps were included. The mean age of patients was 49.43 years (95% CI: 48.27-50.60), with a mean BMI of 26.09 (95% CI: 21.97-30.21), and an average post-harvesting free flap ischemia time of 70.35 min (95% CI: 56.71-83.98). These analyses revealed a heightened risk of total complications (RR: 1.99, 95% CI: 1.61-2.46), complete flap loss (RR: 3.15, 95% CI: 1.32-7.52), partial flap loss (RR: 1.91, 95% CI: 0.92-4.00), hematoma (RR: 1.79, 95% CI: 0.96-3.32), and infection (RR: 2.12, 95% CI: 1.32-3.42) in cases with ischemia time exceeding 60 min. Venous complications predominated in free flap failure cases.

Conclusions: Effectively managing ischemia time could be crucial in free flap breast reconstruction to potentially reduce postoperative complications. Although there is a correlation between managing ischemia time and reducing postoperative complications, further research is needed to investigate the possible causation behind this relationship.

Level of evidence i: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Autologous tissue transfer; Breast reconstruction; Free flap-based reconstruction; Ischemia time; Mastectomy; Microsurgery; Postoperative Complications; Systematic Review.