Vyas Raj M, Dickinson Brian P, Fastekjian Jaco H, Watson James P, DaLio Andrew L, Crisera Christopher A
Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, University of California Los Angeles School of Medicine.
Plast Reconstr Surg. 2008 May;121(5):1519-1526. doi: 10.1097/PRS.0b013e31816b1458.
The lower abdomen is the most popular donor site for autologous tissue breast reconstruction. Several studies have reported abdominal morbidity following pedicled and free flap reconstructions using this donor site, yet few studies have compared the various types of free flaps and investigated specific operative and patient-related factors that are associated with higher rates of abdominal complications.
The authors conducted a retrospective review of all free flap breast reconstructions performed at University of California Los Angeles Medical Center between July of 2002 and July of 2005.
A total of 279 patients underwent 211 unilateral and 68 bilateral reconstructions, totaling 347 flaps. Eleven percent were free transverse rectus abdominis myocutaneous (TRAM) flaps, 52 percent were muscle-sparing free TRAM flaps, and 37 percent were deep inferior epigastric perforator (DIEP) flaps. Mean follow-up was 29.9 months. There were 30 total abdominal complications (10.9 percent of patients), including 17 rectus bulges and five hernias. Free TRAM reconstructions had a significantly higher rate of donor-site complications than did DIEP reconstructions. Bilateral flap harvests and obesity (body mass index >30) were significant risk factors for (1) any donor-site complication and (2) rectus bulge/hernia formation. There was no significant increase in donor-site complications associated with various prior abdominal operations.
Donor-site complications are not uncommon, but paying careful attention to patient comorbidities when selecting an operative approach (bilateral versus unilateral, free TRAM versus DIEP, and so on) can minimize postoperative abdominal complications. Furthermore, the results corroborate the recent literature suggesting there is little functional difference in patients receiving muscle-sparing free TRAM versus DIEP reconstructions.
下腹部是自体组织乳房重建最常用的供区。多项研究报道了使用该供区进行带蒂皮瓣和游离皮瓣重建术后的腹部并发症情况，但很少有研究比较各种游离皮瓣，并探讨与腹部并发症发生率较高相关的具体手术和患者相关因素。
作者对2002年7月至2005年7月在加利福尼亚大学洛杉矶分校医学中心进行的所有游离皮瓣乳房重建手术进行了回顾性研究。
共有279例患者接受了211例单侧和68例双侧重建手术，共347个皮瓣。11%为游离腹直肌肌皮瓣（TRAM），52%为保留肌肉的游离TRAM皮瓣，37%为腹壁下深动脉穿支（DIEP）皮瓣。平均随访时间为29.9个月。共有30例腹部并发症（占患者的10.9%），包括17例腹直肌膨出和5例疝。游离TRAM重建的供区并发症发生率明显高于DIEP重建。双侧皮瓣切取和肥胖（体重指数>30）是（1）任何供区并发症和（2）腹直肌膨出/疝形成的显著危险因素。既往各种腹部手术与供区并发症无显著增加相关。
供区并发症并不少见，但在选择手术方式（双侧与单侧、游离TRAM与DIEP等）时仔细关注患者合并症可将术后腹部并发症降至最低。此外，结果证实了最近的文献表明，接受保留肌肉的游离TRAM与DIEP重建的患者在功能上几乎没有差异。
