Tan Shane, Lim Jane, Yek Jacklyn, Ong Wei Chen, Hing Chor Hoong, Lim Thiam Chye
National University Health System, National University Hospital, Singapre, Singapore.
Arch Plast Surg. 2013 May;40(3):187-91. doi: 10.5999/aps.2013.40.3.187. Epub 2013 May 16.
Our objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group.
All patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999 to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared.
Complications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001).
Based on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap.
我们的目标是比较我院实施的两种常见乳房重建技术的并发症发生率以及每个试验组的成本效益。
选取由同一位外科医生实施了腹壁下深动脉穿支（DIEP）皮瓣和腹直肌肌皮瓣（TRAM）手术的所有患者，并根据年龄以及是否进行腋窝清扫的乳房切除术进行匹配。从每个最终组中按时间顺序选取患者。其余患者按合并症进行匹配。纳入了1999年至2006年期间接受带蒂TRAM皮瓣即刻乳房重建的16例患者和接受DIEP皮瓣手术的16例患者。比较了每组术后2年期间的平均总住院费用、住院时间和并发症情况。
带蒂TRAM皮瓣和DIEP皮瓣出现的并发症均包括脂肪坏死（TRAM组3/16；DIEP组4/16）和其他轻微并发症（TRAM组3/16；DIEP组1/16）。带蒂TRAM组的平均住院时间为7.13天（范围4至12天），DIEP组为7.56天（范围5至10天）。并发症发生率和住院时间的差异均无统计学意义。DIEP组的总住院费用显著高于带蒂TRAM组（P<0.001）。
根据我们的研究，与更新的、更昂贵且操作繁琐的DIEP皮瓣相比，带蒂TRAM皮瓣在乳房重建中仍是一种具有成本效益的技术。
