Houston, Texas From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2013 Dec;132(6):1383-1391. doi: 10.1097/PRS.0b013e3182a805a3.
This study aimed to provide a comprehensive analysis of factors that might contribute to abdominal donor-site morbidity after abdominally based free flap breast reconstruction.
The authors performed a retrospective analysis of all abdominally based free flap breast reconstructions performed from January of 2000 through December of 2010 at their institution.
Overall, 89 of 1507 patients developed an abdominal bulge/hernia (unilateral: 57 of 1044; bilateral: 32 of 463). A unilateral transverse rectus abdominis musculocutaneous (TRAM) flap was significantly more likely to develop an abdominal bulge/hernia than was a muscle-sparing TRAM flap or a deep inferior epigastric perforator (DIEP) flap (9.9 percent versus 3.7 percent versus 5.9 percent; p = 0.004). However, there was no difference in the risk of developing an abdominal bulge/hernia between a muscle-sparing TRAM and a DIEP flap (p = 0.36). Patients who underwent bilateral reconstructions were 1.35 times more likely to develop an abdominal bulge/hernia than patients who underwent unilateral reconstruction, but the difference was not significant. Harvesting more fascia as occurs when both medial and lateral rows are used was significantly associated with need for mesh (p < 0.0001). Overall, placement of mesh for fascia closure reduced the odds of occurrence of bulge/hernia by 70 percent compared with primary fascia closure.
There was no significant difference in the risk of developing abdominal bulge/hernia between bilateral versus unilateral breast reconstruction. For abdominally based free flap breast reconstruction, the extent of the fascia harvested, how it is repaired, and the amount of muscle preserved might play an important role in donor-site morbidity.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在全面分析导致腹侧游离皮瓣乳房重建后腹部供区发病率的因素。
作者对 2000 年 1 月至 2010 年 12 月在本机构行腹侧游离皮瓣乳房重建的所有患者进行了回顾性分析。
总体而言，1507 例患者中有 89 例（单侧：57 例；双侧：32 例）出现腹部膨隆/疝。与保留肌肉的横形腹直肌肌皮瓣（TRAM）或腹壁下动脉穿支皮瓣（DIEP）相比，单侧 TRAM 皮瓣发生腹部膨隆/疝的风险显著更高（9.9%比 3.7%比 5.9%；p=0.004）。但是，保留肌肉的 TRAM 与 DIEP 皮瓣之间发生腹部膨隆/疝的风险无差异（p=0.36）。行双侧重建的患者发生腹部膨隆/疝的风险是行单侧重建患者的 1.35 倍，但差异无统计学意义。当同时使用内侧和外侧两排时，会增加筋膜的采集量，这与需要使用网片显著相关（p<0.0001）。总体而言，与筋膜直接缝合相比，使用网片关闭筋膜可使膨隆/疝的发生几率降低 70%。
双侧与单侧乳房重建相比，发生腹部膨隆/疝的风险无显著差异。对于腹侧游离皮瓣乳房重建，筋膜的采集范围、修复方式以及保留的肌肉量可能在供区发病率方面发挥重要作用。
临床问题/证据水平：治疗性，III 级。
