Effect of corticosteroids on ischemia-reperfusion injury of deep inferior epigastric perforator flap after re-exploration for anastomosis thrombosis: A prospective randomized trial

Simone La Padula; Pasquale M Bufalino; Romain Bosc; Michele Maruccia; Rossella Elia; Francesco D'Andrea; Jean P Meningaud; Barbara Hersant; Rosita Pensato

doi:10.1016/j.bjps.2024.02.053

Effect of corticosteroids on ischemia-reperfusion injury of deep inferior epigastric perforator flap after re-exploration for anastomosis thrombosis: A prospective randomized trial

J Plast Reconstr Aesthet Surg. 2024 Feb 29:92:61-70. doi: 10.1016/j.bjps.2024.02.053. Online ahead of print.

Authors

Simone La Padula¹, Pasquale M Bufalino², Romain Bosc³, Michele Maruccia⁴, Rossella Elia⁴, Francesco D'Andrea², Jean P Meningaud³, Barbara Hersant³, Rosita Pensato²

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy; Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France. Electronic address: drsimonelapadula@gmail.com.
² Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy.
³ Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
⁴ Department of Plastic and Reconstructive Surgery, Università degli Studi di Bari Aldo Moro, P.zza Umberto I, 1 Palazzo Ateneo, Bari, Italy.

PMID: 38493540
DOI: 10.1016/j.bjps.2024.02.053

Abstract

Patients undergoing breast reconstruction with the deep inferior epigastric perforator (DIEP) flap are at risk of arterial and venous thrombosis, necessitating flap salvage surgery. However, this carries the risk of ischemia-reperfusion injury (IRI) and potential significant partial or complete flap loss. The objective of this study was to evaluate the potential benefit of corticosteroids in reducing IRI related complications in DIEP flaps that are returned to the operation theater for attempted salvage after venous or arterial failure. A double-blinded prospective randomized study was conducted between January 2012 and January 2023 on patients scheduled for secondary unilateral breast reconstruction using the DIEP flap technique. Patients were included if they developed post-operative venous or arterial flap thrombosis and experienced DIEP flap IRI following operative take-back and anastomosis revision. The treatment group (TG) received a 5-day course of corticosteroids, while the control group (CG) did not receive any specific treatment. Forty-six patients were enrolled in the study. In the CG, two cases of total flap loss and eight cases of partial flap necrosis were observed, while the TG had only 1 case of partial flap necrosis (p < 0.05). The complete resolution of clinical signs of IRI occurred within 13 ± 2.1 days for the TG and 21 ± 3.5 days for the CG (p = 0.00001). The TG had a significantly shorter hospital stay (11.13 ± 0.38 days) compared with the CG (15.47 ± 1.27 days; p < 0.0001). Targeted corticosteroid therapy following a salvage procedure for vascular thrombosis in DIEP flaps has shown promise as an effective treatment for subsequent IRI. This approach may be considered as a viable option for managing IRI in free flaps. However, further studies involving a larger number of patients are required to substantiate our hypothesis.

Keywords: Arterial thrombosis; Corticosteroids; DIEP flap; Ischemia-reperfusion injury; Microsurgical breast reconstruction; Tamoxifen; Vein thrombosis.