Leuven, Belgium From the Departments of Plastic and Reconstructive Surgery and Radiology, University Hospital Leuven, and the Department of Plastic and Reconstructive Surgery, H. Hart Roeselare.
Plast Reconstr Surg. 2009 Dec;124(6):1754-1758. doi: 10.1097/PRS.0b013e3181bf7e03.
In autologous breast reconstruction after mastectomy, fat necrosis is a rather common complication that may lead to secondary corrective surgery. The understanding of fat necrosis until now has been limited because previous studies were based exclusively on physical examination and used diverse definitions.
The authors retrospectively reviewed the incidence of fat necrosis and the correlation of several risk factors in 202 deep inferior epigastric perforator (DIEP) flaps for breast reconstruction. The incidence of fat necrosis was based on both physical examination and ultrasound imaging. The following risk factors were studied: age, smoking, body mass index, timing of reconstruction, and timing and extent of radiation therapy fields.
Physical examination revealed a palpable mass or nodule in 14 percent of the DIEP flaps (28 of 202). Ultrasound examination added another 21 percent of DIEP flaps (42 of 202) with a firm area of scar tissue (diameter >or=5 mm). The overall ultrasound incidence of fat necrosis in this study was 35 percent (71 of 202). Although the overall ultrasound incidence of fat necrosis was very high, only 7 percent of the DIEP flaps (15 of 202) needed to undergo an extra surgical procedure for removal of this area. In contrast to previous studies, none of the risk factors studied was statistically significant for the occurrence of fat necrosis.
These results suggest that there is no significant association between previously suspected risk factors and fat necrosis. The overall incidence of fat necrosis, however, is much higher than previously accepted, even though the need for corrective surgery is limited.
在乳房切除术后的自体乳房重建中，脂肪坏死是一种相当常见的并发症，可能导致二次矫正手术。到目前为止，对脂肪坏死的理解一直很有限，因为以前的研究仅基于体格检查并使用了不同的定义。
作者回顾性分析了 202 例深部下腹部穿支皮瓣（DIEP）乳房重建中脂肪坏死的发生率和几个危险因素的相关性。脂肪坏死的发生率基于体格检查和超声成像。研究了以下危险因素：年龄、吸烟、体重指数、重建时机、放疗时机和范围。
体格检查发现 14%的 DIEP 皮瓣（28/202）有可触及的肿块或结节。超声检查又发现 21%的 DIEP 皮瓣（42/202）有直径≥5mm 的硬结区。本研究中脂肪坏死的超声总发生率为 35%（71/202）。尽管脂肪坏死的超声总发生率非常高，但只有 7%的 DIEP 皮瓣（202 个中的 15 个）需要进行额外的手术切除该区域。与以前的研究不同，本研究中没有一个危险因素与脂肪坏死的发生有统计学意义。
这些结果表明，以前怀疑的危险因素与脂肪坏死之间没有显著关联。然而，脂肪坏死的总发生率远高于以前的接受程度，尽管需要进行矫正手术的病例有限。
