מתוך medicontext.co.il
By Joene Hendry
WESTPORT, CT (Reuters Health) – Obesity and smoking significantly increase the risk of complications following transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction, according to a report presented on Monday at the 70th annual scientific meeting of the American Society of Plastic Surgeons in Orlando, Florida.
"Active and former smoking and obesity are linked to significantly higher rates of single and multiple flap complications," Dr. Ivica Ducic of Georgetown University in Washington, DC told Reuters Health. He and colleagues retrospectively analyzed the risk factors associated with donor site and flap complications in 224 women who underwent pedicled TRAM flap breast reconstruction over a period of 10 years.
Obesity is a significant risk factor for overall donor site and flap complications, as well as multiple flap complications, delayed wound healing and minor flap necrosis, Dr. Ducic noted. Fifteen percent of the women in the study were obese (BMI over 30). Another 38% were overweight (BMI between 25 and 30), but Dr. Ducic's team found that being overweight was not a significant risk factor for any complications.
"Active smoking significantly increases the risk of multiple flap complications, flap infection, and delayed wound healing," Dr. Ducic said. The researchers identified 15.5% of the women as current smokers. Dr. Ducic's group also found an increased risk of multiple flap complications and delayed TRAM wound healing in the 17.5% of women who were former smokers, which was defined as not smoking for at least 4 weeks.
The investigators identified no significant risk factors for any complication from presurgery radiation and chemotherapy or the use of double pedicled TRAM flaps.
"TRAM is a reasonably safe procedure in properly selected patients," Dr. Ducic told Reuters Health. These findings suggest that physicians could help patients reduce their risk factors by counseling them to quit smoking and to reduce their BMI to below 30 before undergoing TRAM flap breast reconstruction.
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