Cho Min-Jeong, Teotia Sumeet S, Haddock Nicholas T
Dallas, Texas.
From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2017 Jul;140(1):11-18. doi: 10.1097/PRS.0000000000003450.
In recent years, the deep inferior epigastric perforator (DIEP) flap has become the workhorse flap for autologous breast reconstruction. Despite increased reports on DIEP flaps, umbilical complications have not been previously studied. The aesthetics of the umbilicus dictates the beauty of the abdomen, and it is critical for plastic surgeons to minimize the scarring of the umbilicus. In this study, we retrospectively reviewed patients who underwent DIEP flaps to determine the predictors of umbilical complications, and created a classification system of these wounds.
Retrospective review of 323 patients who underwent DIEP flap surgery from 2009 to 2016 was performed. Umbilical stalk heights, widths of fascial diastasis, and abdominal wall thicknesses were measured from computed tomographic scans. Data regarding demographic and patient characteristics were collected.
Of the 323 patients, there were 58 patients that had umbilical complications (18 percent). These patients had statistically higher body mass indexes, heavier flaps, and thicker abdominal walls (p < 0.05). Also, they had statistically higher umbilical stalk heights (29.3 mm versus 18.7 mm), and analysis showed that the likelihood ratio of having umbilical complications was 2.05 at 20.1 mm, 3.05 at 25.4 mm, and 6.43 at 30 mm. Logistic regression analysis revealed that umbilical stalk height, fascial diastasis, age, procedure time, and flap weight were significant predictors (p < 0.05).
Umbilical complications in patients undergoing DIEP flap surgery for breast reconstruction have not been previously studied. Our study shows that the umbilical stalk height plays a significant role, and umbilical wounds can be classified into five types: no wound, minor wound, wound dehiscence, partial necrosis, and total necrosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
近年来，腹壁下深动脉穿支（DIEP）皮瓣已成为自体乳房重建的常用皮瓣。尽管关于DIEP皮瓣的报道增多，但脐部并发症此前尚未得到研究。脐部的美观决定了腹部的美观程度，对于整形外科医生来说，尽量减少脐部瘢痕至关重要。在本研究中，我们回顾性分析了接受DIEP皮瓣手术的患者，以确定脐部并发症的预测因素，并建立了这些伤口的分类系统。
对2009年至2016年接受DIEP皮瓣手术的323例患者进行回顾性分析。通过计算机断层扫描测量脐蒂高度、筋膜分离宽度和腹壁厚度。收集患者的人口统计学和特征数据。
在323例患者中，有58例出现脐部并发症（18%）。这些患者的体重指数在统计学上更高，皮瓣更重，腹壁更厚（p<0.05）。此外，他们的脐蒂高度在统计学上更高（29.3毫米对18.7毫米），分析表明，脐蒂高度为20.1毫米时发生脐部并发症的似然比为2.05，25.4毫米时为3.05，30毫米时为6.43。逻辑回归分析显示，脐蒂高度、筋膜分离、年龄、手术时间和皮瓣重量是显著的预测因素（p<0.05）。
此前尚未对接受DIEP皮瓣手术进行乳房重建的患者的脐部并发症进行研究。我们的研究表明，脐蒂高度起着重要作用，脐部伤口可分为五种类型：无伤口、轻度伤口、伤口裂开、部分坏死和完全坏死。
临床问题/证据水平：治疗性，III级。
