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Erschienen in:
03.06.2023 | Original Paper
Radiographic evidence of neo-vascularization of the lower abdominal soft tissues in patients after abdominoplasty and previous abdominal free flap breast reconstruction
Erschienen in: European Journal of Plastic Surgery | Ausgabe 5/2023
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Background
Abdominal resection ([Ab-R]) is considered an absolute contraindication to abdominally based free flaps (Ab-FF). Yet, as Ab-FF is the current gold standard for autologous breast reconstruction, AQ2 the notion is controversial. Given that the technical feasibility and presumed risk of harvesting Ab-FF after Ab-R are related to postoperative vasculature, we sought to expand the literature by performing an imaging-based study comparing the vascular anatomy of patients undergoing either Ab-FF or Ab-R.
Methods
We conducted a retrospective study of patients who underwent Ab-FF or Ab-R between 2018 and 2022 across three institutions. Patients were included if they had preoperative or postoperative computed tomography (CT) imaging with intravenous contrast of the abdomen of sufficient quality. Demographic, clinical, and operative characteristics were recorded, and abdominal wall vasculature was quantitatively analyzed using three-dimensional rendered CT scans. Individuals were categorized as preoperative “controls,” “Ab-FF,” or “Ab-R” for statistical comparison.
Results
Of the 378 screened individuals, 64 individuals had either preoperative (n = 64) and/or post-Ab-FF (n = 12) or post-Ab-R (n = 10) images considered to be of sufficient quality to be included in our analysis. We observed that the mean diameter of superior vessels (at the origin) of postoperative images (Ab-FF 2.5 mm, Ab-R 2.6 mm) differed significantly from those observed preoperatively (control 1.5 mm). While all 12 cases of Ab-R revealed “prominent” (> 2 mm) superior vessels, these patterns were far less common in controls and after Ab-FF (P < 0.001). A subanalysis of individuals with pre- and postoperative images revealed that the prominent superior vessels appeared postoperatively and significantly more often after Ab-R than after Ab-FF (P = 0.001).
Conclusions
This anatomic study demonstrates that the vascular patterns of the abdominal wall significantly differ after abdominal wall excision. Prominent superior vasculature was observed in all postoperative cases after Ab-R, whereas Ab- FF presented more often with prominent recanalization of inferior vessels. These findings enrich the understanding of the vascular response to Ab-R and Ab-FF and highlight areas for future investigation on the possibility of performing Ab-FF after Ab-R.
Level of evidence: Level III, risk/prognostic study