Laporta Rosaria, Longo Benedetto, Sorotos Michail, Farcomeni Alessio, Amorosi Vittoria, Santanelli di Pompeo Fabio
Plastic Surgery Department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy.
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
Microsurgery. 2017 Oct;37(7):793-799. doi: 10.1002/micr.30203. Epub 2017 Jul 24.
The process of harvesting and performing microsurgical anastomosis may lengthen deep inferior epigastric artery perforator (DIEP) flap breast reconstruction affecting results and patient safety. The aim of the study was to investigate the associations between predictors and operative time (OT).
Between 2004 and 2016, 336 immediate and 68 delayed unilateral reconstructions were performed in 404 patients. Age, weight, height, body mass index (BMI), nulliparity, or pluriparity condition were collected to determine the impact of patient characteristics on OT. Flap weight, mastectomy type, flap zone, perforator number, venous anastomoses, recipient vessels selection, reconstruction timing, contralateral symmetrization, and a dedicated anesthesiologist were analyzed as possible predictors.
Mean OT was 289 min (range, 150-550 min). Using univariate analysis, for each increment of BMI value and patient weight OT increased, respectively, 3.5- and 1.4 min (97.5% CI: 1.768-5.145, 97.5% CI: 0.739-1.949; P < 0.001). Skin-sparing mastectomy (SSM) (97.5% CI: 2.487-36.637; P = 0.025), perforator number, and venous anastomoses (97.5% CI: 24.468-43.690, 97.5% CI: 24.843-50.492; P < 0.001) negatively influenced OT while nipple-sparing mastectomy (NSM) reduced OT of 22.7-min (97.5% CI: -40.333 to -5.098; P = 0.012). The use of circumflex scapular vessels as recipients reduced OT of 75.4-min while internal mammary vessels (IMV) increased OT of 55.8-min (97.5% CI: -88.631 to -62.209, 97.5% CI: 22.918-88.642; P < 0.001). A dedicated anesthesiologist and the learning curve (LC) reduced OT, respectively, of 39.63-min and of 13-min for every year (97.5% CI: -57.119 to -22.137, 97.5% CI: -14.666 to -11.898; P < 0.001). Using multivariate regression, LC was a negative predictor while SSM, perforators number, superficial epigastric vein, IMV, and flap weight were positive predictors (P < 0.001).
The increase of flap weight, related perforators number, and venous drainage negatively influence OT. LC meaning systematic approach for surgery can optimize DIEP flap surgery efficiency.
获取和进行显微外科吻合的过程可能会延长腹壁下深动脉穿支（DIEP）皮瓣乳房重建的时间，从而影响手术效果和患者安全。本研究的目的是调查预测因素与手术时间（OT）之间的关联。
2004年至2016年期间，对404例患者进行了336例即刻和68例延迟单侧重建手术。收集年龄、体重、身高、体重指数（BMI）、未生育或多胎情况，以确定患者特征对手术时间的影响。分析皮瓣重量、乳房切除术类型、皮瓣区域、穿支数量、静脉吻合、受区血管选择、重建时机、对侧对称化以及配备专职麻醉医生等因素作为可能的预测因素。
平均手术时间为289分钟（范围为150 - 550分钟）。单因素分析显示，BMI值和患者体重每增加一个单位，手术时间分别增加3.5分钟和1.4分钟（97.5%可信区间：1.768 - 5.145，97.5%可信区间：0.739 - 1.949；P < 0.001）。保留皮肤的乳房切除术（SSM）（97.5%可信区间：2.487 - 三十六点六三七；P = 0.025）、穿支数量和静脉吻合（97.5%可信区间：24.468 - 43.690，97.5%可信区间：24.843 - 50.492；P < 0.001）对手术时间有负面影响，而保留乳头的乳房切除术（NSM）使手术时间减少22.7分钟（97.5%可信区间：-40.333至-5.098；P = 0.012）。使用旋肩胛血管作为受区血管可使手术时间减少75.4分钟，而使用胸廓内血管（IMV）则使手术时间增加55.8分钟（97.5%可信区间：-88.631至-62.209，97.5%可信区间：22.918 - 88.642；P < 0.001）。配备专职麻醉医生和学习曲线（LC）分别使手术时间每年减少39.63分钟和13分钟（97.5%可信区间：-57.119至-22.137，97.5%可信区间：-14.666至-11.898；P < 0.001）。多因素回归分析显示，学习曲线是负性预测因素，而保留皮肤的乳房切除术、穿支数量、腹壁浅静脉、胸廓内血管和皮瓣重量是正性预测因素（P < 0.001）。
皮瓣重量、相关穿支数量和静脉引流的增加对手术时间有负面影响。学习曲线意味着系统的手术方法可优化DIEP皮瓣手术效率。
