Seidenstuecker Katrin, van Waes Carl, Munder Beatrix I, Claes Karel E Y, Witzel Christian, Roche Nathalie, Stillaert Filip, Mahajan Ajay L, Andree Christoph, Blondeel Phillip N
Department for Plastic and Reconstructive Surgery, Sana Kliniken Düsseldorf, Gräulingerstr. 120, Düsseldorf, DE 40625, Germany.
Department of Plastic and Reconstructive Surgery, University Hospital Gent, De Pintelaan 185, Gent, BE 9000, Belgium.
Breast. 2016 Apr;26:59-66. doi: 10.1016/j.breast.2015.12.005. Epub 2016 Jan 27.
Breast cancer is the commonest form of cancer in women affecting almost a quarter of a million patients in the US annually. 30 percent of these patients and patients with genetic mutations undergo removal of the breast, as highlighted in a high profile celebrity patient. Although breast reconstruction with free microvascular transfer of a DIEAP flap from the abdomen is an ideal form of reconstruction, there have been misgivings about the complexity and potential complications. This study was aimed at clearing these misunderstandings and establishing the value of this form of breast reconstruction.
1036 DIEAP flap breast reconstructions carried out at the University Hospital, Gent (five year period) and at the Sana Kliniken, Düsseldorf (three year period) were included prospectively. Comorbid factors like chemotherapy, radiotherapy, patient age >65 years, BMI >30 and smoking were recorded. Outcomes were evaluated over a mean follow up of 2 years.
Overall complication rate related to the reconstructed breast and donor abdominal area was 6.8 percent. Total flap loss was seen in only 0.8 percent. The mean operating time was less than five hours. Older age, higher BMI, chemotherapy and radiotherapy did not have a significant influence on complication rates, however smoking resulted in significant delay in wound healing in the breast (p = 0.025) and abdominal wounds (p = 0.019).
The DIEAP flap is an excellent option for breast reconstruction, with a low level of donor site morbidity and complications. It is an autologous reconstruction that provides a stable long term result.
乳腺癌是女性中最常见的癌症形式，在美国每年影响近25万名患者。其中30%的患者以及有基因突变的患者会接受乳房切除，一位备受瞩目的名人患者就凸显了这一点。尽管采用从腹部游离微血管转移腹直肌肌皮瓣进行乳房重建是一种理想的重建方式，但人们对其复杂性和潜在并发症存在疑虑。本研究旨在消除这些误解并确立这种乳房重建方式的价值。
前瞻性纳入了在根特大学医院（五年期间）和杜塞尔多夫萨纳诊所（三年期间）进行的1036例腹直肌肌皮瓣乳房重建手术。记录化疗、放疗、患者年龄>65岁、体重指数>30以及吸烟等合并因素。在平均2年的随访期内对结果进行评估。
与重建乳房和供体腹部区域相关的总体并发症发生率为6.8%。仅0.8%的患者出现皮瓣完全坏死。平均手术时间不到5小时。年龄较大、体重指数较高、化疗和放疗对并发症发生率没有显著影响，然而吸烟导致乳房伤口（p = 0.025）和腹部伤口（p = 0.019）的愈合明显延迟。
腹直肌肌皮瓣是乳房重建的极佳选择，供区发病率和并发症水平较低。它是一种自体重建方式，能提供稳定的长期效果。
