Wu Liza C, Bajaj Anureet, Chang David W, Chevray Pierre M
Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2008 Sep;122(3):702-709. doi: 10.1097/PRS.0b013e3181823c15.
Breast reconstruction is best accomplished with lower abdominal tissue, but this results in abdominal donor-site morbidity. The superficial inferior epigastric artery (SIEA) flap is the least invasive method of lower abdominal flap breast reconstruction; however, there are no published data comparing the donor-site morbidity of SIEA flaps to that of transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) flaps.
The authors used a 12-question patient survey and retrospective chart review to compare donor-site function, pain, and aesthetics in 179 patients who had unilateral or bilateral breast reconstruction with 47 SIEA flaps, 49 DIEP flaps, and 136 muscle-sparing free TRAM flaps during a 5-year period.
Unilateral SIEA flap patients scored higher on 10 of the 12 survey questions compared with unilateral muscle-sparing TRAM flap patients, including reporting significantly better postoperative lifting function (p = 0.02) and nearly significantly shorter duration of abdominal pain (p = 0.06). Bilateral reconstruction patients with at least one SIEA flap scored higher on all 12 survey questions, including reporting significantly better ability to get out of bed (sit-up motion) compared with patients with bilateral muscle-sparing TRAM or DIEP flaps (p = 0.02).
Breast reconstruction using SIEA flaps results in significantly less abdominal donor-site morbidity than DIEP flaps in bilateral cases and free muscle-sparing TRAM flaps in unilateral and bilateral cases. These are clinically relevant differences that are perceived by patients and lead to the authors' recommendation to use SIEA flaps for breast reconstruction when possible to minimize abdominal donor-site morbidity.
乳房重建采用下腹部组织效果最佳，但这会导致腹部供区出现并发症。腹壁浅动脉（SIEA）皮瓣是下腹部皮瓣乳房重建中侵入性最小的方法；然而，尚无已发表的数据比较SIEA皮瓣与腹直肌肌皮瓣（TRAM）或腹壁下深动脉穿支皮瓣（DIEP）的供区并发症情况。
作者通过一项包含12个问题的患者调查问卷及回顾性病历审查，比较了179例在5年期间接受单侧或双侧乳房重建的患者的供区功能、疼痛及美观情况，这些患者分别采用了47例SIEA皮瓣、49例DIEP皮瓣和136例保留肌肉的游离TRAM皮瓣。
与单侧保留肌肉的TRAM皮瓣患者相比，单侧SIEA皮瓣患者在12个调查问卷问题中的10个问题上得分更高，包括术后提升功能明显更好（p = 0.02）以及腹痛持续时间几乎明显更短（p = 0.06）。至少有一个SIEA皮瓣的双侧重建患者在所有12个调查问卷问题上得分更高，包括与双侧保留肌肉的TRAM或DIEP皮瓣患者相比，从床上起身（仰卧起坐动作）的能力明显更好（p = 0.02）。
在双侧病例中，使用SIEA皮瓣进行乳房重建导致的腹部供区并发症明显少于DIEP皮瓣；在单侧和双侧病例中，也明显少于保留肌肉的游离TRAM皮瓣。这些是患者能够察觉到的具有临床意义的差异，因此作者建议在可能的情况下使用SIEA皮瓣进行乳房重建，以尽量减少腹部供区并发症。
