Mull Aaron B, Qureshi Ali A, Zubovic Ema, Rao Yuan J, Zoberi Imran, Sharma Ketan, Myckatyn Terence M
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
J Reconstr Microsurg. 2017 Feb;33(2):130-136. doi: 10.1055/s-0036-1593806. Epub 2016 Oct 31.
To evaluate whether the timing of surgery after radiation in autologous breast reconstruction affects major complications. We performed a retrospective review of 454 free flaps (331 patients) for breast reconstruction at a single institution from 2003 to 2014. Charts were reviewed for age, BMI, laterality, flap type (TRAM, msTRAM, DIEP), surgeon, donor vessels (IMA, TD), chemotherapy, smoking, diabetes, hypertension, DVT, venous anastomoses, vein size, and time from radiation (none, < 12 months, or ≥ 12 months). The primary outcome of major complications was defined as partial/total flap loss, thrombosis, ischemia, or hematoma requiring return to the operating room. To identify independent predictors of major complications, a multivariate logistic regression was constructed. Alpha = 0.05 indicated significance in all tests. Average age was 47.4 ± 8.4. Free flaps consisted of msTRAM (41.1%), TRAM (29.6%), or DIEP (29.3%). The donor vessel was IMA in 66.9% of flaps or TD in 33.0% of patients with 90.7% using only one vein and 9.3% with two veins. The average IMA/TDV size was 2.5 cm ± 0.5. Preoperative radiation occurred in 31.2% of flaps. There were 54 flaps with at least one major complication (11.7%). On multivariate regression, only flap type (OR =4.04, < .01) and vein size (OR = 0.13, = 0.02) independently predicted major complications. There was no significant difference in major complications between flaps who had reconstruction within 12 months and greater than 12 months after radiation. Only having a more muscle sparing technique or smaller vein size were independent risk factors for major complications.
评估自体乳房重建中放疗后手术时机是否会影响主要并发症。我们对2003年至2014年在单一机构进行乳房重建的454例游离皮瓣（331例患者）进行了回顾性研究。查阅病历以获取年龄、体重指数、患侧、皮瓣类型（横腹直肌肌皮瓣、改良横腹直肌肌皮瓣、腹壁下动脉穿支皮瓣）、外科医生、供血管（胸廓内动脉、胸背动脉）、化疗、吸烟、糖尿病、高血压、深静脉血栓形成、静脉吻合、静脉大小以及放疗后的时间（无放疗、<12个月或≥12个月）。主要并发症的主要结局定义为部分/全部皮瓣丢失、血栓形成、缺血或需要返回手术室的血肿。为了确定主要并发症的独立预测因素，构建了多因素逻辑回归模型。α = 0.05表明在所有测试中具有显著性。平均年龄为47.4±8.4岁。游离皮瓣包括改良横腹直肌肌皮瓣（41.1%）、横腹直肌肌皮瓣（29.6%）或腹壁下动脉穿支皮瓣（29.3%）。66.9%的皮瓣供血管为胸廓内动脉，33.0%的患者供血管为胸背动脉，90.7%仅使用一条静脉，9.3%使用两条静脉。胸廓内动脉/胸背动脉静脉平均大小为2.5 cm±0.5 cm。31.2%的皮瓣术前接受过放疗。有54例皮瓣至少发生一种主要并发症（11.7%）。在多因素回归分析中，只有皮瓣类型（比值比=4.04，<0.01）和静脉大小（比值比=0.13，=0.02）独立预测主要并发症。放疗后12个月内进行重建的皮瓣与放疗后超过12个月进行重建的皮瓣在主要并发症方面无显著差异。只有采用更保留肌肉的技术或静脉尺寸较小是主要并发症的独立危险因素。
