Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Av. Pio XII 36, 31008 Pamplona, Spain.
J Plast Reconstr Aesthet Surg. 2013 Jan;66(1):80-6. doi: 10.1016/j.bjps.2012.08.024. Epub 2012 Sep 13.
The deep inferior epigastric artery perforator (DIEP) flap is currently one of the preferred methods of autologous breast reconstruction. As a microsurgical flap, it is subjected to ischaemia-reperfusion injury and no reflow phenomenon, both of which are influenced by prolonged ischaemia times. In this work, we review the rates of microvascular complications according to ischaemia times in patients submitted to DIEP flap breast reconstruction.
A retrospective review of 182 patients submitted to breast reconstruction with DIEP flap was conducted. Patients were first classified according to ischaemia time percentiles 25, 50, 75 and 100 comparing the rates of microvascular complications using Fisher's exact test. Next, patients were separated in two groups above and below P(50). Using Student's t-test and Fisher's exact test, univariate analysis was conducted to compare all demographic and surgical variables as well as complications between these groups. Finally, multivariate analysis using binary logistic regression was performed to determine whether or not ischaemia time was an independent risk factor for microvascular complications.
Flap success rate was 97%. Eighteen flaps (9.5%) presented some form of microvascular event. Higher rates of complications were observed as ischaemia time increased (p < 0.05). On multivariate analysis, ischaemia time was found to be an independent risk factor for microvascular complications (odds ratio (OR) 3.81, p = 0.03). Flaps with ischaemia longer than 1.5-2 h were observed to be at higher risk of developing some form of vascular compromise.
Ischaemia time is an independent risk factor for microvascular complications in the DIEP flap for breast reconstruction. Keeping such time to the minimum necessary and avoiding needless delays is likely to improve flap survival.
深下腹直肌穿支皮瓣（DIEP）是目前自体乳房重建的首选方法之一。作为一种显微皮瓣，它会受到缺血再灌注损伤和无复流现象的影响，这两者都受到缺血时间的影响。在这项工作中，我们根据 DIEP 皮瓣乳房再造患者的缺血时间回顾性评估了微血管并发症的发生率。
对 182 例行 DIEP 皮瓣乳房重建的患者进行了回顾性分析。首先，根据缺血时间的百分位数将患者分为 25%、50%、75%和 100%，然后使用 Fisher 确切检验比较微血管并发症的发生率。接下来，将患者分为缺血时间 P(50)以上和以下两组。使用 Student's t 检验和 Fisher 确切检验对这些组之间的所有人口统计学和手术变量以及并发症进行了单变量分析。最后，使用二元逻辑回归进行多变量分析，以确定缺血时间是否是微血管并发症的独立危险因素。
皮瓣成功率为 97%。18 个皮瓣（9.5%）出现了某种形式的微血管事件。随着缺血时间的增加，并发症的发生率更高（p<0.05）。多变量分析显示，缺血时间是微血管并发症的独立危险因素（比值比（OR）3.81，p=0.03）。缺血时间超过 1.5-2 小时的皮瓣更容易出现某种形式的血管功能障碍。
缺血时间是 DIEP 皮瓣乳房重建中微血管并发症的独立危险因素。尽量将缺血时间保持在最短，并避免不必要的延迟，可能会提高皮瓣的成活率。
