Woo Kyong-Je, Mun Goo-Hyun
Department of Plastic Surgery, College of Medicine, Ewha Womans University, Seoul, South Korea.
Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Microsurgery. 2017 Oct;37(7):786-792. doi: 10.1002/micr.30217. Epub 2017 Sep 12.
Various methods have been introduced for estimating deep inferior epigastric artery perforator (DIEP) flap volume based on computed tomography or magnetic resonance angiographic images. However, when radiologic images cannot be obtained, estimations are subjective. The purpose of this study was to develop a prediction model for estimating DIEP flap weight using the pinch test.
The pinch test was performed at three paraumbilical sites using a skin-fold caliper in 107 consecutive patients who underwent DIEP flap breast reconstruction. Multiple linear regression analysis was used to develop a formula to estimate flap weight. Predictor variables included body mass index (BMI, kg/m ), flap height (H, cm), flap width (W, cm), and flap thickness (mm) measured by the pinch test at the following three paraumbilical sites: 5 cm right (R), left (L), and inferior (I) of the umbilicus. The model accuracy was tested using leave-one-out cross-validation.
A prediction model was developed from the multiple regression analysis (R = 89.03%, P < .001); flap weight, g = -1308 + 24.57 × BMI + 6.80 × (R + L)/2 + 7.89 × I + 20.51 × H + 32.55 × W. The formula was implemented in a smartphone application, DIEP-W version 2.0, for real-time use. The mean absolute percentage error in the cross-validation was 12.15%.
DIEP flap weight can be estimated by the pinch test with the developed prediction model in an easy, cost-effective, and relatively accurate manner. This method will improve surgical planning and allow surgeons to provide better counselling for patients when radiologic images are not available.
基于计算机断层扫描或磁共振血管造影图像，已引入多种方法来估计腹壁下深动脉穿支（DIEP）皮瓣体积。然而，当无法获得放射影像时，估计就具有主观性。本研究的目的是开发一种使用捏皮试验来估计DIEP皮瓣重量的预测模型。
在107例连续接受DIEP皮瓣乳房重建的患者中，使用皮肤褶卡钳在三个脐旁部位进行捏皮试验。采用多元线性回归分析来制定估计皮瓣重量的公式。预测变量包括体重指数（BMI，kg/m²）、皮瓣高度（H，cm）、皮瓣宽度（W，cm）以及通过在脐右侧（R）、左侧（L）和下方（I）5 cm处的捏皮试验测量的皮瓣厚度（mm）。使用留一法交叉验证来测试模型准确性。
通过多元回归分析开发了一个预测模型（R² = 89.03%，P <.001）；皮瓣重量，g = -1308 + 24.57×BMI + 6.80×（R + L）/2 + 7.89×I + 20.51×H + 32.55×W。该公式已在智能手机应用程序DIEP-W 2.0版中实现，以便实时使用。交叉验证中的平均绝对百分比误差为12.15%。
使用所开发的预测模型，通过捏皮试验可以简便、经济高效且相对准确地估计DIEP皮瓣重量。当无法获得放射影像时，这种方法将改善手术规划，并使外科医生能够为患者提供更好的咨询。
