What are the possible complications of Boari flaps?

Updated: Nov 12, 2020
  • Author: Sandip P Vasavada, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Complications specific to Boari flaps include ischemia of the flap, reduced lumen size of the flap secondary to thickened bladder wall, and reflux.

Because the blood supply of the Boari flap emanates from its base, the presence of any devascularization injury of the bladder base may cause flap ischemia and eventual necrosis.

The most common cause of flap ischemia is previous pelvic radiation; for this reason, Boari flaps are contraindicated in patients who have received radiation therapy.

Another possible cause of complications is that the bladder base created is too narrow, resulting in an inadequate blood supply to the distal end of the flap.

Yet another complication is that the bladder wall is too thick to form an adequate lumen for the implanted ureter. This situation should be assessed intraoperatively, and, if found, a Boari flap should not be performed.

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