Beugels J, Hoekstra L T, Tuinder S M H, Heuts E M, van der Hulst R R W J, Piatkowski A A
Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, The Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, The Netherlands.
J Plast Reconstr Aesthet Surg. 2016 Sep;69(9):1291-8. doi: 10.1016/j.bjps.2016.04.010. Epub 2016 May 3.
The deep inferior epigastric artery perforator (DIEP) flap is the first choice for autologous breast reconstruction. The aim of this retrospective cohort study was to analyse the recipient- and donor-site complications and compare them between unilateral and bilateral DIEP flap breast reconstructions.
Between January 2010 and December 2014, 530 DIEP flap reconstructions were performed in 426 consecutive patients in three Dutch hospitals. Major and minor complications were categorised into recipient- and donor-site complications. Post-operative flap re-explorations were recorded.
Of the total 530 DIEP flap reconstructions performed (322 unilateral, 104 bilateral), recipient-site complications were major in 9.8% and minor in 20.2%. The patients developed fat necrosis (unilateral 14.0% vs. bilateral 7.7%; OR 1.950; 95% CI 1.071-3.550; p = 0.027) and infection (unilateral 5.6% vs. bilateral 1.9%; OR 3.020; 95% CI 1.007-9.052; p = 0.039) at the recipient site significantly more frequently in the unilateral DIEP flap reconstructions. The donor-site complications were major in 0.9% and minor in 19.5% of the cases. Body mass index (BMI) was significantly associated with complications (donor site: OR 1.137; 95% CI 1.075-1.201; p < 0.001, recipient site: OR 1.073; 95% CI 1.009-1.142; p = 0.026). Flap re-explorations were performed in 5.7% (n = 30) of the cases. Total flap loss occurred in 3.0% (n = 16) of the cases.
Bilateral DIEP flap breast reconstructions can be performed with the same percentage of complications and re-explorations as unilateral reconstructions and even result in less fat necrosis and infection at the recipient site. Higher BMIs are significantly associated with recipient- and donor-site complications.
腹壁下深动脉穿支（DIEP）皮瓣是自体乳房重建的首选。这项回顾性队列研究的目的是分析受区和供区并发症，并比较单侧和双侧DIEP皮瓣乳房重建的并发症情况。
2010年1月至2014年12月期间，荷兰三家医院的426例连续患者接受了530例DIEP皮瓣重建手术。主要和次要并发症分为受区和供区并发症。记录术后皮瓣再次探查情况。
在总共进行的530例DIEP皮瓣重建手术中（322例单侧，104例双侧），受区并发症中主要并发症占9.8%，次要并发症占20.2%。单侧DIEP皮瓣重建患者受区脂肪坏死（单侧14.0%对双侧7.7%；OR 1.950；95% CI 1.071 - 3.550；p = 0.027）和感染（单侧5.6%对双侧1.9%；OR 3.020；95% CI 1.007 - 9.052；p = 0.039）的发生率明显更高。供区并发症中主要并发症占0.9%，次要并发症占19.5%。体重指数（BMI）与并发症显著相关（供区：OR 1.137；95% CI 1.075 - 1.201；p < 0.001，受区：OR 1.073；95% CI 1.009 - 1.142；p = 0.026）。5.7%（n = 30）的病例进行了皮瓣再次探查。3.0%（n = 16）的病例出现了皮瓣完全坏死。
双侧DIEP皮瓣乳房重建的并发症发生率和再次探查率与单侧重建相同，甚至受区脂肪坏死和感染更少。较高的BMI与受区和供区并发症显著相关。
