Global perspectives on practices and preferences in Autologous Free Flap Breast Reconstruction: From flap selection to post-operative care: A descriptive quantitative study

Abstract

BackgroundThe purpose of this study was to evaluate present-day practices in the preparation, peri- and post-operative care for autologous free-flap breast reconstructions (ABR) worldwide, with the aim of enhancing informed decision-making for plastic surgeons during the planning stages of ABR. MethodsA global survey was conducted among 280 plastic surgeons and 39 plastic and reconstructive surgery societies worldwide, inquiring about the flap and donor site selection, surgical actions, perforator imaging and peri-operative care during ABR. ResultsEighty-two responses were received, of which 71% (n=58) were completed questionnaires. The preferred flap choice was the Deep Inferior Epigastric Perforator (DIEP) flap (85%, n=51), with the internal mammary artery as the most commonly used recipient vessel. Pre-operative imaging for ABR was typically performed using Computed Tomography Angiography (75%, n=44) and often combined with a handheld doppler. Handheld doppler was the most frequently used modality to localize perforator vessels during surgery (33%, n=19), with the majority using either one (47%, n=24) or two (51%, n=26) perforators intraoperatively. These preferences were consistent across all clinic types.Post-operatively, flap monitoring was primarily performed by the nursing staff, initially every hour on the first day and then at reduced frequencies on subsequent days.The most commonly used modality for monitoring flap viability was the handheld doppler. The average length of hospital stay was five days. ConclusionThis study provides valuable insights into current preparations, peri- and post-operative care in ABR procedures worldwide, aiding in the development of standardized practices and potentially improving patient outcomes.