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EL-Sabawi et al. Restoration of failed breast reconstruction

causes of failure for the new flap. Previously cited DECLARATIONS
considerations for attempting microsurgical free flap
reconstruction in the setting of prior free flap failure Authors’ contributions
include reassessment of the preoperative preparations, Conception and design of review, performed literature
flap choice, the recipient vessels and anastomotic search protocol, data collection, drafting of manuscript,
technique, the patient’s coagulability and potential final revisions, and final approval of manuscript: B. EL-
for thrombosis, the appropriateness of intraoperative Sabawi
positioning, the postoperative care, and the surgeon’s Design of search protocol, study selection, review
own level of experience [34] . Full blood and coagulation of data, data analysis and interpretation, drafting
tests with consultation of hematologist may also be of manuscript, final revisions and final approval of
required, particularly in those patients without evidence manuscript: A.C. Howell
of obvious technical problem as the cause of flap Design of review, study selection, data interpretation,
[8]
failure. Hamdi et al. reported underlying hematologic drafting of manuscript, final revisions, and final
disorders in 3 out of 14 patients who underwent approval of manuscript: K.M. Patel
tertiary breast reconstruction after failed free flap
reconstruction. Two of these patients went on to have Financial support and sponsorship
successful breast restoration with the use of a second None.
free flap and the other patient underwent successful
implant reconstruction. This suggests that with proper Conflicts of interest
medical management, successful microsurgical There are no conflicts of interest.
restoration in these patients may be attained.
Patient consent
This is the first systematic review to evaluate the Not applicable.
literature and consolidate the available data concerning
autogenous tissue transfer to salvage unsuccessful Ethics approval
breast reconstruction. However, there are several Not applicable.
inherent limitations in this systematic review, including
retrospective study design and the biases within each
of the studies included. Inconsistently reported data and REFERENCES
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202 Plastic and Aesthetic Research ¦ Volume 4 ¦ October 31, 2017