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Background: The transverse myocutaneous gracilis (TMG) flap is a popular choice for autologous breast reconstruction due to its consistent anatomy and reliability, especially for slim patients. While the incidence of donor-site morbidity is comparable with other free flaps, there is no literature about the management of donor-site complications available. Our study aims to provide an overview of encountered complications, associated risk factors and their management using a standardized algorithmic approach.

Methods: A retrospective review of all patients receiving breast reconstruction with a TMG flap at our institution between September 2010 and May 2021 was performed. Demographic data (age, BMI), comorbidities (diabetes, smoking), complication rates (major, minor) and treatment were evaluated. Medical records were screened for reasons and timing of performed reconstructions. Adapted from the Clavien-Dindo classification system, severity of complication was categorized as either class I-II minor or class IIIa-IIIb major. Data on follow-up procedures was collected. A treatment algorithm for the management of commonly occurring donor-site complications was created, based on our long-running institutional experience.

Results: Two-hundred and twenty-five patients (288 flaps) were included in our retrospective analysis. There were 43 (14.9%) minor and 4 (2.7%) major donor-site complications overall. Minor complications included superficial wound breakdown (26/9%), infection (10 cases, 3.5%) and hematoseroma (7 cases, 2.4%). Hematoseroma (2 cases, 0.7%) and severe wound breakdown (2 cases, 0.7%) needing revision surgery were the most common major complications. Patients with lower BMI (mean 22.9 kg/m 2 vs. 24.0 kg/m 2 ; p = .047) and active tobacco use (14.1% vs. 6.3%; p = .046; Relative risk = 1.71 95% CI 1.02-2.88) had a higher occurrence of donor-site complications. Age and operating time were not associated with higher complication rates. Four patients (1.4%) received donor-site refinement surgery.

Conclusion: The TMG flap provides a reliable and safe alternative for breast reconstruction and most donor-site complications can be managed conservatively. Our proposed treatment algorithm aids with decision making in the management of donor-site complications.

Titel:	Management of donor-site complications after breast reconstruction with the transverse musculocutaneous gracilis flap: Proposal of a treatment algorithm.
Autor/in / Beteiligte Person:	Mahrhofer, M ; Russe, E ; Schoeller, T ; Wechselberger, G ; Weitgasser, L
Link:	Zum Volltext
Zeitschrift:	Microsurgery, Jg. 43 (2023-09-01), Heft 6, S. 537-545
Veröffentlichung:	Hoboken, NJ : Wiley-Liss ; <i>Original Publication</i>: New York : Alan R. Liss, [c1983-, 2023
Medientyp:	report
ISSN:	1098-2752 (electronic)
DOI:	10.1002/micr.31010
Schlagwort:	Humans Algorithms Postoperative Complications epidemiology Postoperative Complications etiology Postoperative Complications surgery Reproducibility of Results Retrospective Studies Surgical Wound Dehiscence etiology Mammaplasty adverse effects Mammaplasty methods Myocutaneous Flap transplantation
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Case Reports Language: English [Microsurgery] 2023 Sep; Vol. 43 (6), pp. 537-545. <i>Date of Electronic Publication: </i>2023 Jan 23. MeSH Terms: Mammaplasty* / adverse effects ; Mammaplasty* / methods ; Myocutaneous Flap* / transplantation ; Humans ; Algorithms ; Postoperative Complications / epidemiology ; Postoperative Complications / etiology ; Postoperative Complications / surgery ; Reproducibility of Results ; Retrospective Studies ; Surgical Wound Dehiscence / etiology References: Allen, R. J., & Treece, P. (1994). Deep inferior epigastric perforator flap for breast reconstruction. Annals of Plastic Surgery, 32(1), 32-38. ; Arnez, Z. M., Pogorelec, D., Planinsek, F., & Ahcan, U. (2004). Breast reconstruction by the free transverse gracilis (TUG) flap. British Journal of Plastic Surgery, 57(1), 20-26. ; Berner, J. E., Henton, J. M. D., & Blackburn, A. (2020). 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Entry Date(s): Date Created: 20230123 Date Completed: 20230919 Latest Revision: 20230919 Update Code: 20240513

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Management of donor-site complications after breast reconstruction with the transverse musculocutaneous gracilis flap: Proposal of a treatment algorithm.