Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2010 Aug;126(2):349-357. doi: 10.1097/PRS.0b013e3181de1b67.
The purpose of this study was to evaluate outcomes in breast reconstruction combining lower abdominal flaps with implants and to compare the impact of timing of implant placement on complication and revision rates.
A retrospective review of all patients who underwent free transverse rectus abdominis musculocutaneous, muscle-sparing transverse rectus abdominis musculocutaneous, deep inferior epigastric perforator, or superficial inferior epigastric perforator flaps with implants at a single center over the past decade was performed. Patients were classified as having implant placement at the time of flap reconstruction or during a second procedure. The flap types, implant types/planes, flap and implant-related complications, and revision rates were compared between the groups.
Sixty-nine patients underwent 110 abdominal free flap breast reconstructions with an implant (immediate placement group, 35 patients; staged placement group, 34 patients). The mean follow-up periods were 32 months and 43 months for the immediate placement and staged placement groups, respectively. There was no statistically significant difference in flap type, implant type or plane, flap-related complications, or early implant-related complications between groups. The immediate placement group had a significantly higher rate of late implant-related complications: 25 percent (15 of 59) versus 4 percent (two of 51) in the staged placement group (p = 0.007). The implant revision rate was 63 percent (22 of 35) in the immediate placement group versus 26 percent (nine of 34) in the staged placement group (p = 0.081).
The authors conclude that it is safe to combine implants with autologous lower abdominal free flaps for breast reconstruction. However, it may be preferable to perform this procedure in a staged fashion to minimize late complications and the need for future revisions because of complications or dissatisfaction with the aesthetic result.
本研究旨在评估联合应用下腹部皮瓣和植入物进行乳房再造的结果，并比较植入物放置时机对并发症和翻修率的影响。
回顾性分析了过去十年在一家中心接受游离横行腹直肌肌皮瓣、保留肌肉的横行腹直肌肌皮瓣、深部腹壁下动脉穿支皮瓣或浅层腹壁下动脉穿支皮瓣联合植入物的所有患者。患者分为皮瓣重建时或第二次手术时植入。比较两组皮瓣类型、植入物类型/平面、皮瓣和植入物相关并发症及翻修率。
69 例患者共行 110 例腹部游离皮瓣乳房再造伴植入物（即刻放置组 35 例，分期放置组 34 例）。即刻放置组和分期放置组的平均随访时间分别为 32 个月和 43 个月。两组间皮瓣类型、植入物类型或平面、皮瓣相关并发症或早期植入物相关并发症无统计学差异。即刻放置组晚期植入物相关并发症发生率显著较高：25%（59 例中的 15 例）与分期放置组的 4%（51 例中的 2 例）相比（p = 0.007）。即刻放置组的植入物翻修率为 63%（35 例中的 22 例），分期放置组为 26%（34 例中的 9 例）（p = 0.081）。
作者认为将植入物与自体下腹部游离皮瓣联合用于乳房再造是安全的。然而，分期进行该手术可能更为理想，以尽量减少晚期并发症和因并发症或对美学结果不满意而需要进行的再次手术。
