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Query: UMLS:C0034065 (pulmonary embolism)
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In breast reconstruction, the free TRAM-flap offers many advantages over the pedicled TRAM-flap. Due to its superior perfusion, the free flap rarely develops necrosis. Shaping of the flap is easier due to the lack of the thick muscle pedicle. Because the rectus muscle is spared, there is minimal donor site morbidity. However, the necessary microvascular anastomoses reduced the acceptance of the free TRAM-flap. During a 13-months period, 51 breast reconstructions were performed in 41 patients, 31 unilateral and ten bilateral. 45 flaps served for delayed reconstruction and six flaps for immediate reconstruction. The operations were performed by two teams working simultaneously. The average operating time was 3.9 hours for unilateral and 6.9 hours for bilateral delayed reconstruction. For immediate reconstruction, 6.2 and 6.3 hours were required for uni- and bilateral procedures, respectively. In 38 flaps, the thoracodorsal vessels served as recipient vessels; 13 flaps were anastomosed to the internal mammary artery and vein. Postoperative complications were observed in 13 patients. Three vessel anastomoses had to be revised. In one flap, a partial necrosis occurred; in two flaps hematoma evacuation was necessary. Two patients suffered from fat necroses at the abdomen and one umbilicus was lost. Skin irritations and seromas at the abdomen occurred in five patients. Pulmonary embolism was diagnosed in one patient three weeks postoperatively. Abdominal hernias or bulging in the epigastric area were not observed up to 15 months after reconstruction. These results reveal a low complication rate for breast reconstruction with the free TRAM-flap. The advantages of this technique as compared to the pedicled technique are discussed.
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PMID:[Pedicled versus free TRAM flap for breast reconstruction]. 1033 58

We present our three-year experience of late breast reconstruction with conventional free TRAM flaps in 16 consecutive patients in a Swedish county hospital. The breast reconstruction was done unilaterally in 14 and bilaterally in two, giving a total of 18 free TRAM flaps in 16 patients. Six patients developed anastomotic or systemic thromboembolic events during or after the operation' three developed during the operation, and one required reoperation for postoperative thrombosis. No flaps were lost. Three patients developed deep venous thrombosis (DVT) or pulmonary embolism (PE) postoperatively; the two patients with DVT were later found to be resistant to activated protein C. The patient with a PE had developed multiple metastases by one year postoperatively. We compared the six patients who developed anastomotic and systemic thromboembolic events with those whose operations were uncomplicated and no significant differences were found either in their characteristics or overall events during operation.
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PMID:Three-year evaluation of late breast reconstruction with a free transverse rectus abdominis musculocutaneous flap in a county hospital in Sweden: a retrospective study. 1584 62

Results of our analysis show as that breast reconstruction become a standard part of the care of female patients with breast cancer We will analyse the factors that are important for the primary or secondary breast reconstruction after mastectomy, and also take a closer look on the most recent scientific advances on breast reconstruction and on the protocols regarding them. The breast is the most common site of cancer in Croatia women. Breast cancer is the first leading cause of cancer death among women today. The incidence of female breast cancer in Croatia estimates that approximately 2.200 news cases of female breast will be diagnosed every year. We retrospectively analysed data of 101 female patients undergoing reconstructive surgery for breast reconstruction after mastectomy at Division of Plastic Surgery and Burns, University Hospital Center Split and University Clinic of Plastic and Reconstructive Surgery, Innsbruck, Austria, between 1998 and 2008. For the purpose of outcome assessment, we performed the tree different type of questionnaire: (1) Personal/medical profile (Table 1), (2) Aesthetic assessment (Table 2), and (3) Psychosocial assessment (Table 3). The occurrence of main complications during breast reconstruction (partial necrosis of flap, hernia of donor site, pulmonary embolism, deep venous thrombosis, infection rate, hemathoma and seroma formation, and extrusion of expander/implant) during hospitalisation and follow up period until 6 post operatively were analysed with respect to use different type of reconstructive methods for breast reconstruction. The difference in complication between patients groups was evaluated by chi2-test. The level of significance was set up at p = 0.05. Mann-Whitney test was used to compare the time from mastectomy to breast reconstruction, due to asymmetrical data distribution. The three main variables of this study were to identify significant risk factors, asses the aesthetic outcome, and patient satisfaction with performed different methods for breast reconstruction (LD flap with or without tissue expander and implant, pedicle and free TRAM flaps, and expander /implants only. These variables determined the current guidelines for early and late breast reconstruction after mastectomy such as patient data, age and own decision, relation ship between reconstruction and radiotherapy, and chemotherapy, and finally about breast preserving operation. The result should confirm that breast reconstruction after mastectomy is justified, especially in young women, as well as how essential is team work involved in breast cancer operation and breast reconstruction after mastectomy.
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PMID:Breast reconstruction after mastectomy. 2040 6

We present the case of a 40-year-old patient with sickle cell trait who underwent bilateral breast reconstruction with microvascular TRAM flap transfer. Intraoperatively, the patient developed arterial anastomotic thrombosis of the right breast flap. The left breast flap had already been harvested and was placed on ice. Both anastomoses were then successfully completed. Postoperatively, the patient developed a pulmonary embolism and heparin-induced thrombocytopenia. On postoperative day 12, the left cutaneous Doppler signals were lost, and exploration revealed a thrombosed pedicle and nonviable left breast flap. Pathologic specimen evaluation revealed sickled cells within the flap microvasculature. We believe that prolonged ischemia time and hypothermia precipitated erythrocyte sickling within the flap, causing intra-flap thrombosis that propagated to the pedicle. While sickle cell diseases are not a contraindication to free tissue transfer, we believe that flap cooling should be utilized with caution in this circumstance.
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PMID:Intra-flap thrombosis secondary to acute sickle crisis: a case report. 2297 71