Cleveland Emily C, Fischer John P, Nelson Jonas A, Sieber Brady, Low David W, Kovach Stephen J, Wu Liza C, Serletti Joseph M
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Ann Plast Surg. 2013 Sep;71(3):255-60. doi: 10.1097/SAP.0b013e318286380e.
Donor-site morbidity continues to be a significant complication in patients undergoing abdominally based breast reconstruction. The purposes of our study were to critically examine abdominal donor-site morbidity and to present our algorithm for optimizing donor site closure to reduce these complications.
We performed a retrospective cohort study examining all patients undergoing abdominally based free tissue transfer for breast reconstruction from 2005 to 2011 at our institution. Data were analyzed for overall donor site morbidity, as defined by hernia/bulge or reoperation for debridement and/or mesh removal and for hernia/bulge alone.
A total of 812 patients underwent 1261 free tissue transfers. Fifty-three patients (6.5%) experienced donor-site morbidity, including 27 hernias/bulges (3.3%). No significant difference in overall abdominal morbidity was found between unilateral and bilateral reconstructions (P = 0.39) or the use of muscle in the flap (P = 0.11 unilateral msfTRAM, P = 0.76 bilateral). Prior lower abdominal surgery was associated with higher rates of donor-site morbidity (P = 0.04); hypertension (P = 0.012) and multiple medical comorbidities (P < 0.001) were also significantly more common in these patients. Obesity was the only patient characteristic associated with higher rates of hernia/bulge (P = 0.04). Delayed abdominal would healing was associated with hernia/bulge (P < 0.001); these patients were significantly more likely to develop this complication (odds ratio = 6.3, P < 0.001).
Particular attention must be provided to donor-site closure in obese patients and those with hypertension and multiple medical comorbidities. Low rates of abdominal wall morbidity result from meticulous fascial reconstruction and reinforcement and careful attention to tension-free soft tissue closure.
供区并发症仍然是接受腹部乳房重建患者的一个重要问题。我们研究的目的是严格审视腹部供区并发症，并提出优化供区闭合的方案以减少这些并发症。
我们进行了一项回顾性队列研究，纳入了2005年至2011年在我院接受腹部游离组织移植乳房重建的所有患者。分析了总体供区并发症数据，其定义为疝/膨出或因清创和/或取出补片而再次手术，以及单独的疝/膨出。
共有812例患者接受了1261次游离组织移植。53例患者（6.5%）出现供区并发症，其中27例为疝/膨出（3.3%）。单侧和双侧重建之间（P = 0.39）或皮瓣中使用肌肉与否（单侧肌皮瓣横行腹直肌肌皮瓣，P = 0.11；双侧，P = 0.76）在总体腹部并发症方面未发现显著差异。既往下腹部手术与供区并发症发生率较高相关（P = 0.04）；高血压（P = 0.012）和多种内科合并症（P < 0.001）在这些患者中也明显更常见。肥胖是与疝/膨出发生率较高相关的唯一患者特征（P = 0.04）。腹部伤口延迟愈合与疝/膨出相关（P < 0.001）；这些患者发生这种并发症的可能性显著更高（比值比 = 6.3，P < 0.001）。
必须特别关注肥胖患者以及患有高血压和多种内科合并症的患者的供区闭合。腹壁并发症发生率低得益于细致的筋膜重建和加强以及对无张力软组织闭合的仔细关注。
