Enhanced recovery after breast reconstruction with a pedicled Latissimus Dorsi flap—A prospective clinical study
| Autor: | Christian T. Bonde, Jens H. Højvig, Henrik Kehlet |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Reconstructive surgery medicine.medical_specialty Mammaplasty Breast Neoplasms 030230 surgery Surgical Flaps 03 medical and health sciences Postoperative Complications 0302 clinical medicine Breast cancer DIEP flap medicine Humans Pain Management Latissimus dorsi flap Enhanced recovery after surgery Aged Aged 80 and over Surgical team business.industry Length of Stay Middle Aged medicine.disease Surgery Case-Control Studies 030220 oncology & carcinogenesis Superficial Back Muscles Prospective clinical study Drainage Female Enhanced Recovery After Surgery business Breast reconstruction |
| Zdroj: | Journal of Plastic, Reconstructive & Aesthetic Surgery. 74:1725-1730 |
| ISSN: | 1748-6815 |
| DOI: | 10.1016/j.bjps.2020.11.047 |
| Popis: | We have previously implemented and published an enhanced recovery after surgery (ERAS) program for autologous breast reconstruction using DIEP flaps. The latissimus dorsi (LD) flap is another commonly used flap for autologous breast reconstruction (ABR). The aim of the present study was to use our experience from the ERAS program in DIEP flap reconstruction to optimize our LD breast reconstruction program.We examined our data for a 10-year period (n = 135) and compared this with two different surgical team approaches, within the same unit. One team implemented an ERAS program (n = 18), the other did not (n = 12). Data were collected prospectively. In the ERAS group, patient information was revised, multimodal analgesia was introduced, drain handling was optimised and functional discharge criteria was introduced. Fulfilment of functional discharge criteria were assessed twice daily and specified reasons for not allowing discharge registered.All patients had a breast reconstruction using a unilateral LD flap. Patient and surgical parameters were comparable. Length of stay was significantly shorter in the ERAS group (3.2 days) compared to the historical (6.9) and non-ERAS (TRAS) group (6.3) (p0.0001). Drains were removed significantly faster in the ERAS group (day 3.9) vs day 6.3 (historical) and day 7.0 (TRAS) (p0.0001). Time to drain removal was the main reason for extended LOS. There were no differences in reoperations, readmissions or complications between the three groups. All patients in the ERP group were ambulating, pain free, had abdominal function, were eating and managing personal hygiene on POD 1.LOS was safely reduced to 3 days for LD breast reconstruction in the ERAS group. By discharging patients with drains, it should theoretically be possible to reduce LOS to 1 day, as all other discharge criteria have then been fulfilled. |
| Databáze: | OpenAIRE |
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