Garvey Patrick B, Buchel Edward W, Pockaj Barbara A, Casey William J, Gray Richard J, Hernández José L, Samson Thomas D
Division of General Surgery, Mayo Clinic, Scottsdale, Arizona, USA.
Plast Reconstr Surg. 2006 May;117(6):1711-9; discussion 1720-1. doi: 10.1097/01.prs.0000210679.77449.7d.
Studies comparing similar and sizable numbers of deep inferior epigastric perforator (DIEP) and pedicled transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions are lacking. The authors hoped to determine whether the DIEP flap has advantages over the pedicled TRAM flap for breast reconstruction.
The authors retrospectively reviewed the records of women undergoing breast reconstruction over a 9-year period at a single institution. Patients were grouped by type of reconstruction: DIEP or pedicled TRAM. Only patients with at least 3 months of postoperative follow-up were studied.
A total of 190 women underwent unilateral breast reconstructions (96 DIEP and 94 pedicled TRAM flaps). The patient groups were similar in terms of age, body mass index, preoperative chest wall irradiation and abdominal operations, and cancer stage. The median hospital stay for the DIEP group was shorter than that for the pedicled TRAM group (4 versus 5 days, p < .001). Operative time for the DIEP group (5:53 hours) was longer than that for the pedicled TRAM group (4:46 hours, p < .001). The fat necrosis rates for the pedicled TRAM group were higher (58.5 percent) than those for the DIEP group (17.7 percent, p < .001). Abdominal wall hernias occurred more frequently in pedicled TRAM (16.0 percent) than DIEP patients (1.0 percent, p < .001). Abdominal wall bulge rates were similar for both groups (DIEP 9.4 percent versus pedicled TRAM 14.9 percent).
DIEP flap reconstruction can be performed with lower morbidity rates and shorter hospital stays than pedicled TRAM reconstruction. Specifically, fat necrosis and abdominal wall hernias are less common in DIEP patients than in pedicled TRAM patients, while flap failure and abdominal wall bulging rates are similar in the two patient groups. These data support the DIEP flap as the preferred option over the pedicled TRAM flap for autologous breast reconstruction in postmastectomy patients.
缺乏对数量相近且规模相当的腹壁下深动脉穿支（DIEP）皮瓣和带蒂腹直肌肌皮瓣（TRAM）重建术进行比较的研究。作者希望确定在乳房重建中，DIEP皮瓣是否比带蒂TRAM皮瓣具有优势。
作者回顾性分析了一家机构9年间接受乳房重建的女性患者记录。患者按重建类型分组：DIEP或带蒂TRAM。仅研究术后至少随访3个月的患者。
共有190名女性接受了单侧乳房重建（96例DIEP皮瓣和94例带蒂TRAM皮瓣）。两组患者在年龄、体重指数、术前胸壁放疗及腹部手术史以及癌症分期方面相似。DIEP组的中位住院时间短于带蒂TRAM组（4天对5天，p < 0.001）。DIEP组的手术时间（5小时53分钟）长于带蒂TRAM组（4小时46分钟，p < 0.001）。带蒂TRAM组的脂肪坏死率高于DIEP组（58.5%对17.7%，p < 0.001）。带蒂TRAM组腹壁疝的发生率高于DIEP组患者（16.0%对1.0%，p < 0.001）。两组的腹壁膨出率相似（DIEP组9.4%对带蒂TRAM组14.9%）。
与带蒂TRAM重建术相比，DIEP皮瓣重建术的发病率更低，住院时间更短。具体而言，DIEP患者脂肪坏死和腹壁疝的发生率低于带蒂TRAM患者，而两组患者皮瓣坏死和腹壁膨出率相似。这些数据支持DIEP皮瓣作为乳房切除术后患者自体乳房重建优于带蒂TRAM皮瓣的首选方案。
