Di Candia Michele, Asfoor Ahmed Al, Jessop Zita M, Kumiponjera Devor, Hsieh Frank, Malata Charles M
Eplasty. 2012;12:e31. Epub 2012 Jul 23.
PRESENTED IN PART AT THE FOLLOWING ACADEMIC MEETINGS: 57th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery, September 24-27, 2008, Naples, Italy.45th Congress of the European Society for Surgical Research (ESSR), June 9-12, 2010, Geneva, Switzerland.British Association of Plastic Reconstructive and Aesthetic Surgeons Summer Scientific Meeting, June 30-July 2, 2010, Sheffield Hallam University, Sheffield, UK.
Patients with previous multiple abdominal surgeries are often denied abdominal free flap breast reconstruction because of concerns about flap viability and abdominal wall integrity. We therefore studied their flap and donor site outcomes and compared them to patients with no previous abdominal surgery to find out whether this is a valid contraindication to the use of abdominal tissue.
Twenty patients with multiple previous abdominal operations who underwent abdominal free flap breast reconstruction by a single surgeon (C.M.M., 2000-2009) were identified and retrospectively compared with a cohort of similar patients without previous abdominal surgery (sequential allocation control group, n = 20).
The index and control groups were comparable in age, body mass index, comorbidities, previous chemotherapy, and RT exposure. The index patients had a mean age of 54 years (r, 42-63) and an average body mass index of 27.5 kg/m(2) (r, 22-38). The main previous surgeries were Caesarean sections (19), hysterectomies (8), and cholecystectomies (6). They underwent immediate (n = 9) or delayed (n = 11) reconstructions either unilaterally (n = 18) or bilaterally (n = 2) and comprising 9 muscle-sparing free transverse rectus abdominis muscle and 13 deep inferior epigastric perforator flaps. All flaps were successful, and there were no significant differences in flap and donor site outcomes between the 2 groups after an average follow up of 26 months (r, 10-36).
Multiple previous abdominal surgeries did not predispose to increased flap or donor site morbidity. On the basis of our experience, we have proposed some recommendations for successful abdominal free flap breast reconstruction in patients with previous multiple scars. Careful preoperative planning and the use of some intraoperative adaptations can allow abdominal free flap breast reconstruction to be reliably undertaken in such patients.
部分内容在以下学术会议上展示：意大利整形、重建与美容外科学会第57届会议，2008年9月24 - 27日，意大利那不勒斯。欧洲外科研究学会（ESSR）第45届大会，2010年6月9 - 12日，瑞士日内瓦。英国整形重建与美容外科医师协会夏季科学会议，2010年6月30日 - 7月2日，英国谢菲尔德哈勒姆大学，谢菲尔德。
既往有多次腹部手术史的患者常因担心皮瓣存活及腹壁完整性而被拒绝行腹部游离皮瓣乳房重建术。因此，我们研究了这类患者皮瓣及供区的结局，并与无腹部手术史的患者进行比较，以确定这是否是使用腹部组织的有效禁忌证。
确定了20例既往有多次腹部手术史且由同一外科医生（C.M.M.，2000 - 2009年）进行腹部游离皮瓣乳房重建的患者，并对其进行回顾性研究，与一组无腹部手术史的类似患者（序贯分配对照组，n = 20）进行比较。
研究组和对照组在年龄、体重指数、合并症、既往化疗及放疗暴露情况方面具有可比性。研究组患者的平均年龄为54岁（范围42 - 63岁），平均体重指数为27.5 kg/m²（范围22 - 38）。既往主要手术包括剖宫产（19例）、子宫切除术（8例）和胆囊切除术（6例）。他们接受了即刻（n = 9）或延迟（n = 11）重建，单侧（n = 18）或双侧（n = 2），包括9例保留肌肉的游离腹直肌肌皮瓣和13例腹壁下深动脉穿支皮瓣。所有皮瓣均成功，平均随访26个月（范围10 - 36个月）后，两组在皮瓣及供区结局方面无显著差异。
既往多次腹部手术并不会增加皮瓣或供区的发病率。基于我们的经验，我们针对既往有多处瘢痕的患者成功进行腹部游离皮瓣乳房重建提出了一些建议。仔细的术前规划及一些术中调整可使此类患者可靠地接受腹部游离皮瓣乳房重建术。
