171 posters, 10 topics, 5 sessions, 690 authors, 211 institutions

American Association of Plastic Surgeons Meeting 2022

April 9 - 12 | San Diego, California

P105

Blood Pressure Challenge Reduces Complications In Female To Male Gender-Affirming Chest Reconstruction: A Retrospective Chart Review

Preview of Blood Pressure Challenge Reduces Complications In Female To Male Gender-Affirming Chest Reconstruction: A Retrospective Chart Review

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Poster Presenter

John Slate-Romano

Authors

John Slate-Romano, Victoria Zeyl, Darden Beqiri, Joseph Crozier, Paul Liu, Daniel Kwan

Affiliations

Warren Alpert Medical School, Brown University, Providence, Rhode Island, 02903, Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island 02903

Part of Topic

Gender Affirmation

Blood Pressure Challenge (BPC) Reduces Hematoma Complications In Gender-Affirming Chest Reconstruction: A Retrospective Chart Review of 119 Consecutive Patients

John J. Slate-Romano, B.S., Victoria G. Zeyl, B.A., Dardan Beqiri, M.D., Joseph Crozier, M.A., Paul Liu, M.D., Daniel Kwan, M.D.

Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island 02903

PURPOSE

Postoperative complication rates for masculinizing gender-confirming chest reconstructions are between 11 and 33 percent. With this study, the authors investigate the effectiveness of using a blood pressure challenge, whereby the patient’s blood pressure is medically elevated intraoperatively to reveal potential bleeding vessels which can be addressed with additional hemostasis, to reduce postoperative complications with a particular interest in hematomas.

METHODS

Data Extraction

•A retrospective chart review of 119 consecutive patients who underwent masculinizing gender-confirming chest reconstructions over a six-year period by a single surgeon was conducted.

•Surgeries were separated into a control group that did not utilize a blood pressure challenge (BPC) and a group that did use a BPC.

•Demographics, surgical characteristics, and postoperative complications were compared between the two groups.

BPC Protocol

•A BPC was conducted prior to skin closure by administering vasoconstrictors to raise the patient’s SBP by 30 mmHg from the patient’s preoperative or anesthesia induction blood pressure.

•During this time, the surgeon evaluated the exposed tissue to locate injured vessels and applied appropriate hemostasis techniques prior to closing the incision.

•This same techniques of locating injured vessels and maintaining hemostasis were used for patients in the control group without medically elevating the patient’s blood pressure.

RESULTS

Patient Demographics:

•No significant difference between control group and BPC group in terms of age, BMI, preoperative BP, race, psychological comorbidities, and perioperative medications.

•Comorbidities were similar between the two groups except there was a greater percentage of patients with diabetes in the BPC group (8.7%) compared to the control group (0%).

Surgery Characteristics and Surgical Approach:

•In the BPC group, there was a greater proportion of DIM and fewer periareolar approaches compared to the control group.

•There was a greater percentage of free nipple grafts in the BPC group compared to the control group.

•Amount of tissue removed, EBL, and surgery time were similar between the two groups.

Post-operative Complications:

•Hematoma rate was higher in the control group (20%) compared to the BPC group (1.5%, p<0.001).

•Overall Complication rate was higher in the control group (32% compared to the BPC group (8.7%, p=0.0012)

•Return to operating room rate was higher in the control group (12%) compared to the BPC group (0%, p=0.0046)

CONCLUSION

Using an intraoperative blood pressure challenge was associated with reduced hematomas and overall complication in patients undergoing masculinizing gender-confirming chest reconstruction. Guidelines for blood pressure challenge goals should be established to standardize care and reduce complications.