Tomouk Taj, Mohan Anita T, Azizi Alex, Conci Elena, Brickley Elizabeth B, Malata Charles M
School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, UK; Department of Plastic Surgery, John Radcliffe Hospital, Headley Way, Oxford, UK.
Department of Plastic and Reconstructive Surgery, Addenbrooke's University Hospital, Hills Rd, Cambridge, UK; Division of Plastic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA; Restoration of Appearance and Function charitable Trust (RAFT), Mount Vernon Hospital, Rickmansworth Rd, Middlesex, UK.
J Plast Reconstr Aesthet Surg. 2017 Nov;70(11):1505-1513. doi: 10.1016/j.bjps.2017.05.044. Epub 2017 Jun 3.
The use of abdominal tissue in post-mastectomy autologous breast reconstruction is a popular choice among reconstructive surgeons. This is the first study to evaluate donor complications comparing unilateral, bilateral, and bipedicled DIEP breast reconstructions.
A retrospective chart review was conducted of all women undergoing rib-preserving DIEP free flap breast reconstruction at a University Hospital between 2008 and 2015 by the senior surgeon (CMM).
A total of 130 patients were included in this study and were divided into three groups: unipedicled unilateral (n = 93), unipedicled bilateral (n = 19), and bipedicled unilateral (n = 18). Relative to the unipedicled unilateral group, the age and BMI-adjusted odds of complication were almost two-fold higher in the bilateral group [Odds ratio (95% CI): 1.97 (0.63, 6.19)] and approximately halved in the bipedicled group [Odds ratio (95% CI): 0.59 (0.22, 1.61)]; however, these associations were not statistically significant. Overall, 75% of complications were managed conservatively. The majority of Clavien-Dindo grade 3 complications were observed in participants from the unipedicled unilateral group (84%), whereas no patients in the bipedicled group developed morbidity that required recourse to surgery or readmission to hospital.
Although further research with greater statistical power will be valuable, the results of this investigation provide evidence that donor site morbidity of bipedicled DIEP free flap breast reconstructions does not increase when compared with those of unipedicled unilateral and unipedicled bilateral surgical procedure types.
在乳房切除术后自体乳房重建中使用腹部组织是重建外科医生中一种流行的选择。这是第一项比较单侧、双侧和双蒂腹壁下动脉穿支（DIEP）乳房重建供区并发症的研究。
对2008年至2015年期间在一家大学医院由资深外科医生（CMM）进行保留肋骨的DIEP游离皮瓣乳房重建的所有女性进行回顾性病历审查。
本研究共纳入130例患者，分为三组：单蒂单侧（n = 93）、单蒂双侧（n = 19）和双蒂单侧（n = 18）。相对于单蒂单侧组，双侧组经年龄和体重指数调整后的并发症发生率几乎高出两倍[比值比（95%置信区间）：1.97（0.63，6.19）]，而双蒂组则约减半[比值比（95%置信区间）：0.59（0.22，1.61）]；然而，这些关联无统计学意义。总体而言，75%的并发症通过保守治疗。大多数Clavien-Dindo 3级并发症见于单蒂单侧组的参与者（84%）；而双蒂组没有患者出现需要手术或再次入院治疗的发病情况。
尽管进行更具统计学效力的进一步研究将很有价值，但本调查结果提供了证据，表明与单蒂单侧和单蒂双侧手术类型相比，双蒂DIEP游离皮瓣乳房重建的供区发病率并未增加。
