Kappos Elisabeth A, Jaskolka Jeff, Butler Kate, O'Neill Anne C, Hofer Stefan O P, Zhong Toni
Toronto, Ontario, Canada; and Basel, Switzerland.
From the Division of Plastic and Reconstructive Surgery, University Health Network, and the William Osler Health Center, University of Toronto; and the Division of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel.
Plast Reconstr Surg. 2017 Jul;140(1):170-177. doi: 10.1097/PRS.0000000000003427.
A major shortcoming associated with abdominal tissue breast reconstruction is long-term abdominal wall morbidity. Although abdominal muscle size on computed tomographic angiography has been correlated with morbidity following many abdominal operations, it has not been studied for breast reconstruction. Therefore, the authors evaluated the association between preoperative computed tomography angiography-derived measurements of abdominal core muscles and postoperative abdominal wall morbidity after abdominal tissue breast reconstruction.
In this retrospective matched case-control study of women who underwent microsurgical abdominal flap breast reconstruction at one institution between January 2011 and June 2015, the authors evaluated all cases of postoperative bulge/hernia, matched by type of abdominal flap and body mass index in a ratio of 1:2 to controls without bulge/hernia. The authors obtained morphometric measurements of abdominal core muscles on preoperative computed tomographic angiographs. Using univariable and multivariable logistic regressions, the authors examined the effects of clinical risk factors and computed tomographic angiography morphometric measurements on postoperative bulge/hernia formation.
Of the 589 patients who underwent abdominal free flap breast reconstruction, symptomatic bulges/hernias were identified in 35 patients (5.9 percent). When compared to the 70 matched controls, multivariable analysis showed that decreased area of rectus abdominis muscle (OR, 0.18; p < 0.01) and increased inter-rectus abdominis distance (OR, 1.14; p < 0.01) on computed tomographic angiography were significant risk factors associated with postoperative bulge/hernia.
Preoperative computed tomographic angiography allows objective measurements of the patient's abdominal muscle anatomy that provide valuable prognostic information on the risk of bulge/hernia formation following abdominally based microsurgical breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
腹部组织乳房重建的一个主要缺点是长期腹壁并发症。尽管计算机断层血管造影术显示的腹肌大小与许多腹部手术后的并发症相关，但尚未针对乳房重建进行研究。因此，作者评估了术前计算机断层血管造影术测量的腹部核心肌肉与腹部组织乳房重建术后腹壁并发症之间的关联。
在这项对2011年1月至2015年6月期间在一家机构接受显微外科腹部皮瓣乳房重建的女性进行的回顾性匹配病例对照研究中，作者评估了所有术后隆起/疝的病例，按腹部皮瓣类型和体重指数以1:2的比例与无隆起/疝的对照组进行匹配。作者在术前计算机断层血管造影照片上获得了腹部核心肌肉的形态测量数据。使用单变量和多变量逻辑回归，作者研究了临床危险因素和计算机断层血管造影形态测量数据对术后隆起/疝形成的影响。
在589例行腹部游离皮瓣乳房重建的患者中，35例（5.9%）出现有症状的隆起/疝。与70例匹配的对照组相比，多变量分析显示，计算机断层血管造影显示腹直肌面积减小（比值比，0.18；P<0.01）和腹直肌间距增加（比值比，1.14；P<0.01）是与术后隆起/疝相关的显著危险因素。
术前计算机断层血管造影术能够客观测量患者的腹部肌肉解剖结构，为基于腹部的显微外科乳房重建术后隆起/疝形成风险提供有价值的预后信息。
临床问题/证据级别：风险，III级。
