Stockholm, Sweden From the Department of Reconstructive Plastic Surgery, Karolinska University Hospital; and the Department of Molecular Medicine and Surgery, Section of Plastic Surgery, Karolinska Institute.
Plast Reconstr Surg. 2012 Jul;130(1):10-18. doi: 10.1097/PRS.0b013e3182547aaf.
Autologous tissue transfer is often indicated to achieve improved tissue quality during breast reconstruction after radiotherapy. The authors evaluated satisfaction with postmastectomy breast reconstruction among irradiated patients. The aim was to compare deep inferior epigastric perforator (DIEP) and latissimus dorsi flaps regarding satisfaction with aesthetic outcome between patients and plastic surgeons.
Patients who underwent reconstruction with 24 consecutive DIEP flaps and 21 consecutive latissimus dorsi flaps in combination with prostheses were reviewed retrospectively. They received the Michigan Outcomes Study 36-Item Short Form Health Survey and a complementary form regarding patient satisfaction. They were photographed, and aesthetic results were evaluated by an independent board of plastic surgeons.
There was no significant difference between the groups regarding demographic data or 36-Item Short Form Health Survey results. Plastic surgeons found the DIEP flap superior regarding size (p = 0.024) and shape (p = 0.039), whereas patients were more satisfied with the size (p = 0.046) and shape (p = 0.017) of the latissimus dorsi flap when patients' and surgeons' opinions were compared. Discrepancy between patients' and surgeons' opinions was verified with weighted kappa analysis. Regarding the donor scar, the latissimus dorsi flap was favored compared with DIEP flap reconstruction by both patients (p = 0.036) and surgeons (p = 0.001).
There is a difference between patients' and plastic surgeons' opinions regarding breast reconstruction outcomes in the irradiated breast. The patients were more satisfied with latissimus dorsi flap reconstruction, which may relate to the donor-site scar. Surgeons favored DIEP flap reconstruction with regard to the size and shape of the breast.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
自体组织转移常用于在放疗后进行乳房重建以改善组织质量。作者评估了接受过放疗的患者对乳房重建的满意度。目的是比较腹壁下动脉穿支皮瓣（DIEP）和背阔肌皮瓣在患者和整形外科医生对美学效果的满意度方面的差异。
回顾性分析了 24 例连续 DIEP 皮瓣和 21 例连续背阔肌皮瓣联合假体重建的患者。他们接受了密歇根结果研究 36 项简明健康调查问卷和一份关于患者满意度的补充问卷。对他们进行了拍照，并由一个独立的整形外科医生委员会对美学结果进行评估。
两组患者的人口统计学数据或 36 项简明健康调查问卷结果无显著差异。整形外科医生认为 DIEP 皮瓣在大小（p = 0.024）和形状（p = 0.039）方面更优，而患者对背阔肌皮瓣的大小（p = 0.046）和形状（p = 0.017）更满意，当比较患者和外科医生的意见时。使用加权 Kappa 分析验证了患者和外科医生意见之间的差异。关于供区瘢痕，患者（p = 0.036）和外科医生（p = 0.001）都更喜欢背阔肌皮瓣重建，而不是 DIEP 皮瓣重建。
在接受过放疗的乳房中，患者和整形外科医生对乳房重建结果的意见存在差异。患者对背阔肌皮瓣重建更满意，这可能与供区瘢痕有关。外科医生更喜欢 DIEP 皮瓣重建，因为其乳房的大小和形状。
临床问题/证据水平：治疗性，III 级。
