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Preventing Abdominal Donor-Site Morbidity in Autologous Breast Reconstruction Using OviTex Reinforced Tissue Matrix
Goutam K. Gadiraju
1, Paul Indyk
2, Renee Gao
3, Yizhuo Shen
4, Yibin Zhang
1, Madeline Duncan
1, Allison Pellegrino
1, Hannah Shi
1, Justin Broyles
5
1. Harvard Medical School, Boston, MA, United States. 2. Paracelsus Medical University, Salzburg, Austria. 3. UMass Chan Medical School, Worcester, MA, United States. 4. Yale School of Medicine, New Haven, CT, United States. 5. Brigham and Women's Hospital, Boston, MA, United States.
Background: Autologous breast reconstruction using the DIEP flap is the gold standard for care, though abdominal-site morbidity remains a concern. While mesh reinforcement reduces bulges and hernias, there is an effort to identify cost-effective resorbable options. This study evaluates whether retro-rectus reinforcement using OviTex 1S is associated with lower postoperative abdominal morbidity compared with primary fascial closure alone.
Methods: We performed a retrospective analysis of DIEP flap reconstructions from January 2023 to September 2024. Patients with pre-existing hernias or less than six months of follow-up were excluded. The primary outcome was composite abdominal-site morbidity (bulge or incisional hernia). Abdominal-site complications were also recorded. Multivariable regression analysis was utilized to identify independent predictors of abdominal-site morbidity.
Results: The study included 123 patients (mean age 50.8; average BMI 28.0), with 43 receiving OviTex and 80 undergoing primary closure. Median follow-up was 13.5 months. There were no significant differences in demographic or operative data between cohorts. Abdominal bulge occurred significantly less frequently in the OviTex cohort compared to primary closure (0% vs. 12.5%, p=0.01). After controlling for medical history and operative characteristics, OviTex reinforcement was associated with significantly lower odds of developing an abdominal bulge (OR 0.87, p=0.01). Rates of donor-site complications, such as seroma (6.2% vs. 4.7%) and hematoma (2.5% vs. 2.3%), remained low and similar between groups.
Conclusion: Abdominal wall reinforcement with OviTex during DIEP flap harvest is associated with lower rates of postoperative abdominal bulge compared to primary closure. These findings suggest OviTex is an effective resorbable option for reducing donor-site morbidity. Larger cohort sizes are necessary to define the impact of mesh reinforcement on long-term hernia rates.
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