| Abstract [eng] |
Autologous breast reconstruction, especially using free flaps (DIEP, TRAM, PAP, LD, SGAP, IGAP, TUG), is considered the gold standard due to its natural appearance, long-term outcomes, and improved quality of life compared to implants. However, donor-site complications – such as seromas, hernias, infections, and contour deformities – remain a significant clinical challenge. Outcomes depend on flap type, surgical technique, patient risk factors (BMI, smoking, comorbidities), and aesthetic expectations. Most systematic reviews focus on recipient-site complications, while donor-site complications remain under-investigated. Studies that address donor sites mainly concentrate on abdominal and dorsal flaps, leaving informational gaps regarding thigh and gluteal donor sites. This review examines over 100 clinical studies to assess donor-site complications and aesthetic outcomes across different flap types, aiming to support more informed surgical planning and patient counseling. Results. Abdominal wall complications included bulging and laxity in up to 33% of cases and hernias in up to 7.1%, with TRAM flaps generally showing higher rates than DIEP. Wound dehiscence ranged from 12% to 39%, seromas from 1% to 48%, and infections from 1% to 12%. Fat necrosis occurred in up to 11% of cases, while umbilical necrosis was rare, around 2–3%. Risk factors included obesity, previous surgeries, and large flap weight. A few studies reported patient dissatisfaction with scar aesthetics and abdominal contour. The most common donor-site complication for back flaps was seroma formation, with incidence ranging from 20% to 79%. This was significantly reduced with the use of quilting sutures and progressive tension closure techniques. Shoulder dysfunction and limited range of motion occurred in 10-45% of patients, most often temporary. Some studies reported long-term pain or movement restrictions. Hematomas and contour deformities were rare. The most frequent donor-site complications for thigh flaps were wound dehiscence up to 13%, seromas up to 5%, and infections 2-3%. High scar tension and elevated BMI were significant risk factors. Functional impairments were minimal – most patients resumed normal walking quickly. Contour irregularities and inner thigh tightness were more common after TUG/TMG procedures. Quilting sutures and proper intraoperative patient positioning helped reduce complication rates. For gluteal flaps, the most common donor-site complication was seroma formation 4-12%, especially with IGAP. Wound dehiscence occurred in 2-4% of cases. Buttock contour deformities were reported in up to 23% of cases, more frequently following SGAP flaps. Pain, sensory changes, and gait disturbances were rare, typically mild and short-term. Most studies did not report any injury to the sciatic nerve. Scars were generally well hidden, particularly when using the “in-the-crease” technique. Conclusions. Donor-site complications strongly depends on the flap type, patient BMI, surgical technique (including whether muscle-sparing approaches were used), quilting sutures, and closure tension. Aesthetic and functional outcomes varied considerably between donor sites – abdominal and gluteal regions more often caused dissatisfaction with contour. Most complications were minor and manageable with conservative treatment. Serious functional impairments were rare when flaps were harvested using microsurgical techniques and appropriate patient selection. |
