A retrospective investigation of abdominal visceral fat, body mass index (BMI), and active smoking as risk factors for donor site wound healing complications after free DIEP flap breast reconstructions.

Publication date: Available online 28 March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Floyd W. Timmermans, Pèdrou B. Westland, Stefan Hummelink, Joep Schreurs, Marijn Hameeteman, Dietmar J.O. Ulrich, Nicholas Slater
BackgroundThe deep inferior epigastric artery perforator (DIEP) flap is one of the most common techniques for breast reconstruction. Body Mass Index (BMI) is considered an important predictor of donorsite healing complications such as wound dehiscence. The use of computed tomography (CT) techniques has shown a more precise and objective method to assess visceral adipose tissue. It remains unclear whether quantified visceral fat results in more accurate predictions of abdominal wound healing complications than BMI.Patients and MethodsA total of 97 DIEP flap patients were retrospectively evaluated. The patient's abdominal visceral fat (AVF) was quantified on CT angiography (CTA). Patients were postoperatively assessed for abdominal wound healing complications. We analyzed for the correlations between AVF, BMI, and dehiscence and established a logistic regression model to assess the potential high profile predictors in anatomic and patient characteristics such as weight, smoking and diabetes.ResultsWe included 97 patients, which resulted in 24 patients (24.7%) with some degree of abdominal dehiscence. No significant differences were seen between the dehiscence group and the non-dehiscence group, except for smoking (P=0.002). We found a significant correlation between AVF and BMI (R=0.282, p=0.005), but neither was significant in predicting donor site dehiscence. Smoking greatly increased the likelihood of developing wound dehiscence (OR 11.4, p=<0.0001).ConclusionsAVF and BMI were not significant in predicting abdominal wound healing complications after DIEP flap reconstruction. This study significantly established the contributing risk factor of active smoking (OR 11.4, p=<0.001) for the development of abdominal wound dehiscence in DIEP-patients.