Global perspectives on practices and preferences in autologous free flap breast reconstruction: From flap selection to postoperative care A descriptive quantitative study.

Background: The purpose of this study was to evaluate the present-day practices in the preparation, peri-, and postoperative care for patients undergoing autologous free flap breast reconstructions (ABR) worldwide, with the aim of enhancing informed decision-making for plastic surgeons during the planning stages of ABR. Methods: A global survey was conducted among 280 plastic surgeons and 39 plastic and reconstructive surgery societies worldwide, enquiring about flap and donor site selection, surgical actions, perforator imaging, and perioperative care during ABR. Results: Eighty-two responses were received, among which 71% (n=58) were completed questionnaires. The preferred flap of choice was the deep inferior epigastric perforator flap (85%, n=51), with the internal mammary artery as the most commonly used recipient vessel. Preoperative imaging for ABR was typically performed using computed tomography angiography (75%, n=44) and often combined with a handheld Doppler. Handheld Doppler was the most frequently used modality to localize perforator vessels during surgery (33%, n=19), with the majority using either one (47%, n=24) or two (51%, n=26) perforators intraoperatively. These preferences were consistent across all clinic types.Postoperatively, flap monitoring was primarily performed by the nursing staff, initially every hour on the first day and at reduced frequencies on subsequent days.The most commonly used modality for monitoring flap viability was the handheld Doppler. The average length of hospital stay was 5 days. Conclusion: This study provides valuable insights into the current preparations and peri- and postoperative care in ABR procedures worldwide, aiding in the development of standardized practices and potentially improving patient outcomes.