Chen Constance M, Halvorson Eric G, Disa Joseph J, McCarthy Colleen, Hu Qun-Ying, Pusic Andrea L, Cordeiro Peter G, Mehrara Babak J
New York, N.Y. From the Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center.
Plast Reconstr Surg. 2007 Nov;120(6):1477-1482. doi: 10.1097/01.prs.0000288014.76151.f7.
The deep inferior epigastric perforator (DIEP) flap is a major advance in breast reconstruction, but many surgeons are reluctant to use it because of concerns about a higher flap loss rate when compared with free/muscle-sparing transverse rectus abdominis myocutaneous (TRAM) flaps. Previous studies, however, have not statistically analyzed the relationship of patient characteristics to outcome. This study evaluates the authors' institutional experience with immediate postoperative complications following DIEP and free/muscle-sparing TRAM flaps.
Results of 200 consecutive free/muscle-sparing TRAM and DIEP flaps performed by two surgeons at a single institution between 2003 and 2005 were reviewed using a prospectively maintained database. The incidence of flap complications was compared. Patient demographics, procedure type, diagnosis, adjuvant treatment, and complications were recorded. Outcome variables included total and partial flap loss, infection, seroma, hematoma, wound-healing problems, fat necrosis, and mastectomy flap necrosis.
One hundred forty-three patients were treated with 159 free/muscle-sparing TRAM flaps and 41 DIEP flaps. The demographics of the two groups were statistically similar. No statistically significant differences were noted in total or partial flap loss.
In the authors' series, the use of the DIEP flap did not result in more postoperative flap-related complications when compared with the free/muscle-sparing TRAM flap. Furthermore, no patient characteristics were statistically associated with a more successful result. The authors conclude that in patients whose anatomy reveals perforators of adequate size, the DIEP flap is a safe and reliable procedure for breast reconstruction.
腹壁下深动脉穿支（DIEP）皮瓣是乳房重建的一项重大进展，但许多外科医生因担心与游离/保留肌肉的横行腹直肌肌皮瓣（TRAM）相比皮瓣丢失率更高而不愿使用。然而，以往的研究尚未对患者特征与手术结果之间的关系进行统计学分析。本研究评估了作者所在机构应用DIEP皮瓣和游离/保留肌肉的TRAM皮瓣术后即刻并发症的情况。
回顾了2003年至2005年间由两名外科医生在同一机构连续进行的200例游离/保留肌肉的TRAM皮瓣和DIEP皮瓣手术结果，使用前瞻性维护的数据库。比较皮瓣并发症的发生率。记录患者的人口统计学资料、手术类型、诊断、辅助治疗及并发症。结果变量包括皮瓣全部和部分丢失、感染、血清肿、血肿、伤口愈合问题、脂肪坏死和乳房切除皮瓣坏死。
143例患者接受了159例游离/保留肌肉的TRAM皮瓣和41例DIEP皮瓣手术。两组的人口统计学资料在统计学上相似。在皮瓣全部或部分丢失方面未发现统计学上的显著差异。
在作者所述的系列研究中，与游离/保留肌肉的TRAM皮瓣相比，应用DIEP皮瓣并未导致更多与皮瓣相关的术后并发症。此外，没有患者特征在统计学上与更成功的结果相关。作者得出结论，对于解剖结构显示有足够大小穿支的患者，DIEP皮瓣是一种安全可靠的乳房重建手术方法。
