Gill Paul S, Hunt John P, Guerra Aldo B, Dellacroce Frank J, Sullivan Scott K, Boraski Jonathan, Metzinger Stephen E, Dupin Charles L, Allen Robert J
Division of Trauma and Critical Care and the Division of Plastic Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Plast Reconstr Surg. 2004 Apr 1;113(4):1153-60. doi: 10.1097/01.prs.0000110328.47206.50.
This study examined 758 deep inferior epigastric perforator flaps for breast reconstruction, with respect to risk factors and associated complications. Risk factors that demonstrated significant association with any breast or abdominal complication included smoking (p = 0.0000), postreconstruction radiotherapy (p = 0.0000), and hypertension (p = 0.0370). Ninety-eight flaps (12.9 percent) developed fat necrosis. Associated risk factors were smoking (p = 0.0226) and postreconstruction radiotherapy (p = 0.0000). Interestingly, as the number of perforators increased, so did the incidence of fat necrosis. There were only 19 cases (2.5 percent) of partial flap loss and four cases (0.5 percent) of total flap loss. Patients with 45 flaps (5.9 percent) were returned to the operating room before the second-stage procedure. Patients with 29 flaps (3.8 percent) were returned to the operating room because of venous congestion. Venous congestion and any complication were observed to be statistically unrelated to the number of venous anastomoses. Overall, postoperative abdominal hernia or bulge occurred after only five reconstructions (0.7 percent). Complication rates in this large series were comparable to those in retrospective reviews of pedicle and free transverse rectus abdominis musculocutaneous flaps. Previous studies of the free transverse rectus abdominis musculocutaneous flap described breast complication rates ranging from 8 to 13 percent and abdominal complication rates ranging from 0 to 82 percent. It was noted that, with experience in microsurgical techniques and perforator selection, the deep inferior epigastric perforator flap offers distinct advantages to patients, in terms of decreased donor-site morbidity and shorter recovery periods. Mastery of this flap provides reconstructive surgeons with more extensive options for the treatment of postmastectomy patients.
本研究对758例用于乳房重建的腹壁下深动脉穿支皮瓣进行了风险因素及相关并发症方面的检查。与任何乳房或腹部并发症显著相关的风险因素包括吸烟（p = 0.0000）、重建后放疗（p = 0.0000）和高血压（p = 0.0370）。98例皮瓣（12.9%）发生了脂肪坏死。相关风险因素为吸烟（p = 0.0226）和重建后放疗（p = 0.0000）。有趣的是，随着穿支数量的增加，脂肪坏死的发生率也随之增加。仅有19例（2.5%）出现部分皮瓣丢失，4例（0.5%）出现完全皮瓣丢失。45例患者（5.9%）在二期手术前返回手术室。29例患者（3.8%）因静脉淤血返回手术室。观察发现，静脉淤血和任何并发症与静脉吻合数量在统计学上无关联。总体而言，仅5例重建术后发生了腹部疝或膨出（0.7%）。该大型系列研究中的并发症发生率与带蒂和游离腹直肌肌皮瓣回顾性研究中的发生率相当。此前关于游离腹直肌肌皮瓣的研究描述的乳房并发症发生率为8%至13%，腹部并发症发生率为0%至82%。值得注意的是，随着显微外科技术和穿支选择经验的积累，腹壁下深动脉穿支皮瓣在降低供区发病率和缩短恢复期方面为患者提供了明显优势。掌握这种皮瓣为重建外科医生提供了更多治疗乳房切除术后患者的选择。
