Andrades Patricio, Fix R Jobe, Danilla Stefan, Howell Robert E, Campbell William J, De la Torre Jorge, Vasconez Luis O
Division of Plastic Surgery, Department of Surgery, University of Alabama in Birmingham, Birmingham, AL 35294-3411, USA.
Ann Plast Surg. 2008 May;60(5):562-7. doi: 10.1097/SAP.0b013e31816fc372.
Muscle sparing and perforator flaps techniques for breast reconstruction have focused in reducing the donor site morbidity. Theoretically this may result in a less robust blood supply to the flap. The purpose of this study was to assess flap ischemic complications with the pedicle, free, and the different muscle sparing transverse rectus abdominis myocutaneous (TRAMs) flaps for breast reconstruction and determine the factors associated with these complications. A total of 301 consecutive patients that underwent 399 breast reconstructions were retrospectively reviewed. Patient, oncologic, and reconstruction data were recorded. A flap ischemic complication scale was design including: wound healing problems, skin flap necrosis, fat necrosis, partial flap loss, and total flap loss. Analysis of donor site complications, bilateral and unilateral reconstructions were also performed. There were 147 pedicle TRAM and 154 free TRAM with the following subgroup distribution: MS-0 = 102; MS-1 = 37; and MS-2 = 15 patients. The groups were comparable in relation to age, comorbidities, cancer stage, and treatment. The overall complication rate after reconstruction had no statistical differences between the groups. The variables related to flap ischemia were statistically lower in the free TRAM. Mild and severe fat necrosis were the indicators with a statistical difference. The MS-0 group had lower ischemic complications and fat necrosis than the pedicled group, but no differences were observed for the MS-1 and MS-2 groups. The same results were seen in the unilateral reconstructions but not in the bilateral ones. No differences in donor site bulging or hernia were observed between the groups. In our study, the free TRAM flap demonstrated lower ischemic complications than the pedicle TRAM. A trend for decreased flap blood supply when more muscle is preserved and less number of perforators are used with a constant tissue volume was observed.
用于乳房重建的肌肉保留和穿支皮瓣技术一直致力于减少供区并发症。从理论上讲，这可能会导致皮瓣的血供不够强健。本研究的目的是评估带蒂、游离以及不同的肌肉保留横行腹直肌肌皮瓣（TRAM）用于乳房重建时皮瓣的缺血性并发症，并确定与这些并发症相关的因素。对连续接受399例乳房重建手术的301例患者进行了回顾性研究。记录了患者、肿瘤学和重建数据。设计了一个皮瓣缺血性并发症量表，包括：伤口愈合问题、皮瓣坏死、脂肪坏死、部分皮瓣丢失和完全皮瓣丢失。还对供区并发症、双侧和单侧重建进行了分析。有147例带蒂TRAM和154例游离TRAM，其亚组分布如下：MS-0 = 102例；MS-1 = 37例；MS-2 = 15例。这些组在年龄、合并症、癌症分期和治疗方面具有可比性。重建后的总体并发症发生率在各组之间无统计学差异。与皮瓣缺血相关的变量在游离TRAM中统计学上较低。轻度和重度脂肪坏死是有统计学差异的指标。MS-0组的缺血性并发症和脂肪坏死比带蒂组低，但MS-1组和MS-2组未观察到差异。单侧重建中观察到相同的结果，但双侧重建中未观察到。各组之间在供区隆起或疝气方面未观察到差异。在我们的研究中，游离TRAM皮瓣的缺血性并发症低于带蒂TRAM。当保留更多肌肉且在组织体积不变的情况下使用更少的穿支时，观察到皮瓣血供减少的趋势。
