Spear Scott L, Ducic Ivica, Low Mervin, Cuoco Frank
Division of Plastic Surgery, Georgetown University Medical Center, Washington, DC, USA.
Plast Reconstr Surg. 2005 Jan;115(1):84-95.
The purpose of this study was to examine the effect of postreconstruction radiation therapy on patients undergoing pedicled TRAM flap breast reconstruction. Post-TRAM radiation patients were compared with patients who received pre-TRAM radiation and a control TRAM-only group who received no radiation. Overall aesthetic appearance, evidence of symmetry, flap contracture, and hyperpigmentation were assessed by blinded reviewers. A total of 171 pedicled TRAM reconstructions were performed in 150 patients. Total flap complications were seen in 49.5 percent of the control patients, 57.1 percent of pre-TRAM radiation patients, and 50 percent of post-TRAM radiation patients but were not statistically different. The complete flap necrosis rate was 0.6 percent and the partial flap necrosis rate was 7.6 percent, again with no statistical differences among the groups. Donor-site complications occurred in approximately one third of patients in each of the groups. Deep venous thrombosis and pulmonary embolus each occurred once and only in the post-TRAM radiation group. In terms of overall aesthetic outcome, symmetry, and contracture, the control group consistently rated better than the pre-TRAM (p = 0.021, p = 0.03, p = 0.03, respectively) and the post-TRAM (p = 0.0001, p = 0.0001, and p =0.0001, respectively) radiation groups. The control group also had clinically and statistically significant less hyperpigmentation than the post-TRAM radiation group (p = 0.0002). In contrast, irradiated postreconstruction patients had scores, including aesthetic outcome, symmetry, and contracture, worse than those of irradiated prereconstruction patients. When these two groups were compared with each other, except for contracture, no statistical significance, because of a small patient sample, was found. Neither preoperative nor postoperative radiation increased the risk for flap or donor-site complications. In contrast, radiation of any type did affect aesthetic appearance, symmetry, contracture, and hyperpigmentation. The authors recommend that TRAM flap breast reconstruction be postponed in those patients known or expected to receive postmastectomy radiation.
本研究的目的是探讨重建后放射治疗对接受带蒂横行腹直肌肌皮瓣（TRAM瓣）乳房重建患者的影响。将TRAM瓣重建后接受放疗的患者与TRAM瓣重建前接受放疗的患者以及未接受放疗的单纯TRAM瓣对照组患者进行比较。由不知情的评审人员评估整体美观度、对称性、皮瓣挛缩和色素沉着情况。150例患者共进行了171例带蒂TRAM瓣乳房重建手术。对照组患者皮瓣总并发症发生率为49.5%，TRAM瓣重建前接受放疗的患者为57.1%，TRAM瓣重建后接受放疗的患者为50%，但差异无统计学意义。皮瓣完全坏死率为0.6%，部分坏死率为7.6%，各组间同样无统计学差异。每组约三分之一的患者出现供区并发症。深静脉血栓形成和肺栓塞各发生1次，且仅发生在TRAM瓣重建后接受放疗的组中。在整体美观效果、对称性和挛缩方面，对照组的评分始终高于TRAM瓣重建前放疗组（分别为p = 0.021、p = 0.03、p = 0.03）和TRAM瓣重建后放疗组（分别为p = 0.0001、p = 0.0001、p = 0.0001）。对照组的色素沉着在临床和统计学上也显著少于TRAM瓣重建后放疗组（p = 0.0002）。相比之下，重建后接受放疗的患者在美观效果、对称性和挛缩等方面的评分低于重建前接受放疗的患者。当将这两组患者相互比较时，除挛缩外，由于患者样本量小，未发现统计学意义。术前或术后放疗均未增加皮瓣或供区并发症的风险。相比之下，任何类型的放疗都会影响美观度、对称性、挛缩和色素沉着。作者建议，对于已知或预期接受乳房切除术后放疗的患者，应推迟进行TRAM瓣乳房重建。
