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AAPS 2024 Annual Meeting Abstracts
synthesis, as well as improving collagen type 1 and fibro-
nectin synthesis in FA-treated samples. 20 micro-molar TA
in parallel cultures led to irregular elastin aggregates, caus-
ing widespread elastosis.
CONCLUSION: TA in micro-molar levels can counteract
the elastin inhibitory eects of Vitamin D3, HA, and FA,
potentially elucidating the poor survival of fat grafts in HA-
rich regions.
D116. WITHDRAWN
D117. SKIN GRAFT FAILURE AT THE
TIME OF MUSCLE FREE TISSUE
TRANSFER IN THE COMORBID
POPULATION UNDERGOING LIMB
SALVAGE PROCEDURES
Karen R. Li, BBA1, Christian X. Lava,
MS1, Sabrina Deleonibus, MS1, Winnie Li,
BS1, Cameron M. Akbari, MD2, Richard
C. Youn, MD3, Christopher E. Attinger,
MD3, Karen K. Evans, MD3
1Georgetown School of Medicine,
Georgetown, DC, USA, 2Department of
Vascular Surgery, MedStar Georgetown
University Hospital, Georgetown, DC, USA,
3Department of Plastic and Reconstructive
Surgery, MedStar Georgetown University
Hospital, Georgetown, DC, USA
PURPOSE: The use of muscle free flaps (FF) with the
supplementary use of a split-thickness skin graft (STSG)
is often required to complete coverage for complex chronic
lower extremity (LE) wounds. This study aims to charac-
terize the use of STSG after LE muscle FF and compare
the outcome between immediate versus delayed timing of
STSG.
METHODS: A retrospective review of 92 patients receiving
a STSG after LE muscle FF was performed. Demographics,
comorbidities, FF and STSG operative details, and com-
plications were collected. Primary outcomes included full
healing, greater than 85% take, and graft failure anytime
postoperatively.
RESULTS: After FF procedure, 71.4% (n=65) received
immediate STSG placement and 28.6% (n=26) received
a delayed STSG. Median time for delayed STSG was 12
(IQR = 9) days, of which 73.1% (n=19) patients received
wound bed prep in the interim. 31.8% (n=20) immedi-
ate STSG achieved full healing compared to 16.0% (n=4)
patients in delayed STSG (p=0.186). Overall graft failure
rate was 31.5%, occurring at a median time of 35 (IQR =
54) days. History of Charcot arthropathy independently pre-
dicted higher rates of graft failure on multivariate logistic
regression (OR = 7.06, p=0.021). Rates of graft failure were
not significant for immediate (27.0%) and delayed (42.3%)
STSG (p=0.157).
CONCLUSION: While there are certain LE comorbidi-
ties that significantly contribute to higher graft failures,
our results do not show significant dierences in outcomes
for immediate versus delayed staging of LE muscle FF and
STSG procedures.
D118. INGUINAL LYMPH NODE TO VEIN
ANASTOMOSIS - ‘THE CLEVELAND
CLINIC EXPERIENCE AND TECHNICAL
REFINEMENTS’
Sonia Kukreja-Pandey, MD1, Elizabeth
A. Bailey, MD2, Wei F. Chen, MD1
1Cleveland Clinic, Cleveland, OH, USA,
2University of Pittsburgh, Pittsburgh, PA,
USA
PURPOSE: Lymphaticovenular anastomosis (LVA) is
eective and minimally invasive but is technically demand-
ing. Also, lower trunk and genital swelling are less respon-
sive to distal LVA. Inguinal lymph node to vein anastomosis
(LNVA) oers a potential solution by decompressing
lymph channels from multiple lymphosomes with a single
anastomosis.
METHODS: We retrospectively reviewed patients under-
going LNVA from September 2022 to September 2023.
Demographics, indications, and procedural strategies were
analyzed. Postoperative outcomes were assessed using stan-
dardized measures.
RESULTS: Nineteen patients (11 females, 8 males; age
14-68 years) underwent 18 LNVA procedures. Indications
included genital/lower truncal swelling (10/19), prior leg
LVA (3/19), or leg liposuction (6/19). Groin ultrasound,
indocyanine green (ICG), isosulphan blue injections, lym-
phoscintigraphy, Savi Scout and vein finder were used for
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PRS Global Open • 2024
lymph nodes and veins mapping. Lymph node size, shape,
echotexture, hilar blood flow and ICG flow direction guided
target node selection. Anterior surface of the lymph node
was punctured for side to end anastomosis with a nearby
vein. Brisk lymph fluid egress was seen in 8/18 limbs. In 2
limbs plan was converted to LVA in the groin due to no suit-
able lymph nodes. LNVA was performed alone (6/18), or
with simultaneous LVA (8/18) or liposuction (4/18). Twelve
patients have demonstrated clinical improvement while 5
reported no change.
CONCLUSION: Our systematic preoperative and opera-
tive strategies have streamlined safe execution of LNVA
with encouraging early results.
D119. IDENTIFYING RISK FACTORS FOR
ELECTIVE REVISIONS AFTER BREAST
RECONSTRUCTION
Casey Zhang, BS, Shayan M. Sarrami,
MD, Vivian Wang, BS, Pooja Reddy, BS,
Carolyn De La Cruz, MD
University of Pittsburgh Medical Center,
Pittsburgh, PA, USA
PURPOSE: There is an increase in women seeking breast
reconstruction following mastectomies and a rise in revi-
sion surgeries to provide cosmetically acceptable results. It
is critical that plastic surgeons give appropriate education
regarding patient’s reconstructive planning. This study asses
the rate of cosmetic revisions required after breast recon-
struction and the associated risk factors.
METHODS: A retrospective review included patients
undergoing breast reconstruction with a single surgeon
from 2012-2017 following mastectomy. Revision surgery
was considered any elective procedure not included in the
initial reconstructive plan. Univariate analysis evaluated
associated surgical and demographic risk factors.
RESULTS: Our cohort included 412 breast reconstruc-
tion patients, seventy-five (18.2%) received a revision sur-
gery. There was no significant dierence found between
abdominally based flaps, latissimus flap with an implant,
or implant-based reconstruction (26.2% vs 20.5% vs
16.3%, respectively). There was significance when con-
sidering the total number of cosmetic surgeries, planned
and unplanned. Implants had the most procedures (2.06
operations), followed by latissimus flaps (1.68 operations),
and finally abdominally based flaps (1.21 operations, p
=0.000). Logistic regression showed prior radiation was
associated with increased likelihood of revision surgery
(OR 1.85, p=0.025). Subgroup analysis of patients who
received abdominally based free flaps showed significant
association between increased preoperative BMIs and
revisions (p=0.043).
CONCLUSION: Additional cosmetic surgeries are neces-
sary for some breast reconstruction patients. Pre-operative
factors, specifically radiation and BMI, were associated
with increased revision rates. In our cohort, the type of
reconstruction was not predictive of revision. This knowl-
edge base provides informed patient decision-making and
improved surgical planning.
D120. OUTCOMES IN IMMEDIATE,
DELAYED-IMMEDIATE, AND
DELAYED AUTOLOGOUS BREAST
RECONSTRUCTION: A FOURTEEN-YEAR
NATIONAL DATABASE ANALYSIS
Maheen F. Akhter, BS1, Jennifer
K. Shah, BS, BAH1, Devi Lakhlani, BA1,
Christian Palacios, MPH1, Uchechukwu
O. Amakiri, BS2, Clifford C. Sheckter,
MD1, Haripriya S. Ayyala, MD3, Rahim
S. Nazerali, MD1
1Stanford University, Div. of Plastic and
Reconstructive Surgery, Stanford, CA, USA,
2Icahn School of Medicine at Mount Sinai,
New York, NY, USA, 3Yale University, Div.
of Plastic and Reconstructive Surgery, New
Haven, CT, USA
PURPOSE: There exists a lack of consensus regarding opti-
mal timing and modality of autologous breast reconstruc-
tion (ABR). This study compares postoperative outcomes
among patients undergoing immediate, delayed-immediate,
and delayed ABR.
METHODS: Using the MerativeTM MarketScan®
Research Databases, 2007-2021, adult female breast cancer
patients undergoing mastectomy with concurrent or subse-
quent ABR were identified and stratified by ABR modality.
Demographics, timing of adjuvant radiotherapy, and post-
operative outcomes were recorded. Univariate testing and
multivariate regression modeling were performed.