Effect of Obesity on Flap and Donor-Site Complications in Pedicled TRAM Flap Breast Reconstruction

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Abstract
Background: The detrimental effects of obesity on pedicled and free transverse rectus abdominis myocutaneous (TRAM) flap reconstructions, including flap loss, hematoma, and donor-site hernia, are well documented. This study examined the effect of obesity on complications in patients undergoing pedicled TRAM flap breast reconstruction. Methods: A retrospective review of 224 pedicled TRAM flaps in 200 patients over a 10-year period was carried out. Patients were divided into three groups: normal weight (body mass index < 25; 47 percent of patients), overweight (body mass index 25 to 29.9; 38 percent), and obese (body mass index ≥ 30; 15 percent). There were no statistically significant differences in age, smoking history, radiation/chemotherapy history, distribution of flap pedicle types, timing of reconstruction, percentage of delay procedures performed, or expanders implanted among the three subgroups. Donor-site, flap, and other miscellaneous complications were compared among subgroups, and logistic regression analysis was used to identify risk factors for flap and donor-site complications. Results: Compared with normal weight and overweight patients, obese patients had a statistically significantly higher incidence of multiple flap complications (36.7 percent versus 10.6 percent and 36.7 percent versus 10.5 percent, respectively; p = 0.0036) and partial flap necrosis (21.6 percent versus 5.8 percent and 21.6 percent versus 7.1 percent; p = 0.01 and p = 0.03, respectively). Lastly, obese patients had a significantly higher incidence of overall (one or more) donor-site complications when compared with normal weight patients (53.3 percent versus 31.9 percent; p = 0.0499). Conclusion: Obese patients, in contrast to normal weight and overweight patients, have a statistically significantly higher risk for developing overall (one or more) and multiple flap complications, overall donor-site complications, TRAM flap delayed wound healing, and minor flap necrosis.