Houston, Texas; Philadelphia, Pa.; and Washington, D.C. From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center; the Divisions of Plastic Surgery and Biostatistics, University of Pennsylvania; and the Department of Plastic Surgery, Georgetown University.
Plast Reconstr Surg. 2010 Oct;126(4):1142-1153. doi: 10.1097/PRS.0b013e3181f02520.
The purpose of this two-part study was to demonstrate the impact of free flap breast reconstruction on the abdominal wall. In Part I, the authors present the results for unilateral techniques.
A blinded, prospective, cohort study was performed involving 234 free flap breast reconstruction patients. Patients were evaluated preoperatively, and followed for 1 year. At each encounter, patients underwent abdominal strength testing using the Upper and Lower Rectus Abdominis Manual Muscle Function Test, the Functional Independence Measure, and psychometric testing using the 36-Item Short-Form Health Survey. Patients also completed a satisfaction questionnaire specific to breast reconstruction. Statistical analysis included the Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon signed rank tests.
Two-hundred thirty-four patients were enrolled. Of these, 157 underwent reconstruction (75 of which were unilateral), completed follow-up, and were included in the analysis. There was a significantly greater decline in upper abdominal strength in patients undergoing muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap surgery compared with deep inferior epigastric perforator (DIEP) flap surgery at early (p = 0.01) and late follow-up (p = 0.02). Unilateral superficial inferior epigastric artery flap procedures (n = 3) were too few for a meaningful conclusion to be reached. Lower abdominal and Functional Independence Measure scores showed no significant differences. Psychometric testing showed that there was a significant decline in physical health within the free TRAM flap group. No significant difference among groups was appreciable.
In unilateral cases, the impact of the muscle-sparing free TRAM flap versus the DIEP flap follows theoretical predictions based on the degree of muscle sacrifice: the muscle-sparing free TRAM flap demonstrated a greater decline than the DIEP flap in certain measurable parameters.
本研究分为两部分，旨在展示游离皮瓣乳房重建对腹壁的影响。在第一部分中，作者展示了单侧技术的结果。
进行了一项盲法、前瞻性队列研究，共纳入 234 例游离皮瓣乳房重建患者。患者在术前进行评估，并随访 1 年。在每次就诊时，患者均接受腹部力量测试，包括上、下腹直肌手动肌肉功能测试、功能独立性测量以及使用 36 项简短健康调查问卷进行的心理测量测试。患者还完成了针对乳房重建的满意度问卷。统计分析包括 Kruskal-Wallis、Mann-Whitney、Friedman 和 Wilcoxon 符号秩检验。
共纳入 234 例患者，其中 157 例接受重建（75 例为单侧），并完成随访，纳入分析。与深下腹动脉穿支皮瓣（DIEP）游离皮瓣手术相比，行保留肌肉的游离横形腹直肌肌皮瓣（TRAM）游离皮瓣手术的患者在早期（p = 0.01）和晚期（p = 0.02）的上腹部力量下降更为显著。由于单侧腹壁下动脉皮瓣手术（n = 3）数量过少，无法得出有意义的结论。下腹部和功能独立性测量评分无显著差异。心理测量测试显示，游离 TRAM 皮瓣组的身体健康状况显著下降。各组之间没有明显差异。
在单侧病例中，保留肌肉的游离 TRAM 皮瓣与 DIEP 皮瓣的影响符合基于肌肉切除程度的理论预测：保留肌肉的游离 TRAM 皮瓣在某些可测量参数上的下降幅度大于 DIEP 皮瓣。
