The efficacy of preoperative mapping of perforators in reducing operative times and complications in perforator flap breast reconstruction.

Reconstruction using perforator flaps can be technically demanding and in inexperienced hands may result in longer operative times and increased costs. This has implications for the postoperative recovery of patients as well as associated complications such as atelectasis and deep vein thrombosis. This study examined different aspects of perforator flap reconstruction including operative times, ischaemia time, flap re-exploration rate, complications and inpatient length of stay. The mean operative times were as follows: for Deep Inferior Epigastric Artery Perforator (DIEAP) flaps it was 4 h 49 min (n=17), for bilateral DIEAP it was 7 h 23 min (n=12) and for SGAP it was 4 h 56 min (n=2). Since CT preoperative perforator mapping was introduced it has resulted in a mean reduction of operative time by 1 h 16 min (21%). This has also led to costs saving of 471 pounds sterling per patient. Preoperative mapping of perforators can reduce operative times as well as allowing the selection of the most reliable perforators beforehand. Good flap perfusion is assured which leads to reduced length of stay as well as fewer complications such as postoperative fat necrosis and delayed healing. Reduced operative times also contribute to major cost savings for the hospital. Although both CT and Duplex perforator mapping can reduce operative times, this study found that operative times were reduced more after CT scanning was introduced.

Donor-site morbidity after autologous costal cartilage harvest in ear reconstruction and approaches to reducing donor-site contour deformity.

BACKGROUND: Harvesting of rib as a source of cartilage can result in significant donor-site morbidity. In experienced hands, excellent results from using autologous rib cartilage are achievable for ear reconstruction, rhinoplasty, and otolaryngology. The authors report the morbidity associated with the harvest of costal cartilage in 42 patients who underwent ear reconstruction. METHODS: The notes were examined retrospectively and further data were collected with a questionnaire. Patients noted their experience of pain, clicking, and satisfaction with the donor site. Fifteen patients underwent additional clinical assessments of their donor scar and contour deformity using a standardized scale. Five donor sites were reconstructed with spare cartilage left over from carving the ear framework. RESULTS: The results showed that pain and clicking of the chest wall represented the commonest complaints. These peaked in the first week after surgery and diminished slowly over 3 months. The donor-site scar and deformity were acceptable to most patients. There was an improvement in the contour deformity of the chest wall harvest site in the five patients who underwent reconstruction of their donor site. CONCLUSIONS: To improve the outcome for patients undergoing cartilage harvest, efforts must be made to further reduce pain and donor-site morbidity. Reconstruction of the donor site with spare cartilage should be attempted where possible to improve the contour defect of the donor site. Refinements in the methods of cartilage harvest or donor-site reconstruction may achieve this in the future.