Samargandi Osama A, Winter Jessica, Corkum Joseph P, Al Youha Sarah, Frank Simon, Williams Jason
Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Plastic and Reconstructive Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
Microsurgery. 2017 Nov;37(8):937-946. doi: 10.1002/micr.30244. Epub 2017 Sep 26.
Our aim was to determine whether the thoracodorsal (Td) vessels have comparable clinical outcomes to the internal mammary (IM) vessels as recipients for autologous free tissue transfer for breast reconstruction.
Systematic searches of MEDLINE, EMBASE, CENTRAL, and World of Science from inception to June 2016 were performed by two independent reviewers. Studies that included adult females undergoing autologous free tissue transfer for breast reconstruction were selected. The two comparison groups were the use of IM or Td as recipient vessels. Our primary outcome was rate of flap survival. We assessed the methodologic quality of included studies using the JADAD and MINOR scales.
A total of 1897 patients underwent 2644 free abdominal flap tissue transfer in the 10 articles that were included in our analysis. There was one randomized controlled study (Jadad score 2/5) and 9 nonrandomized controlled studies (MINORS scores 11-19/24). There was no difference between the uses of either vessel in terms of flap loss (1.18; 95% CI 0.71-1.95). Complication rate among the IM vessels ranged from 5 to 12%, compared with 3.4-12% among Td vessels. Hematoma and seroma rates were variable. Fat necrosis was higher with Td vessels in two studies. Performing Td vessels anastomosis was associated with shorter operative time and higher risk of encountering unusable vessel.
Both recipient vessels are safe, reliable and demonstrate equivocal results in the absence of contraindications. Utilizing either as a first-line vessel is reasonable, depending on surgeons' preference or certain clinical scenarios.
Therapeutic, Level of evidence: III.
我们的目的是确定胸背（Td）血管作为自体游离组织移植进行乳房重建的受区血管，其临床效果是否与胸廓内（IM）血管相当。
两名独立审阅者对MEDLINE、EMBASE、CENTRAL和科学在线数据库进行了系统检索，检索时间范围从建库至2016年6月。纳入的研究为成年女性接受自体游离组织移植进行乳房重建。两个比较组分别是使用IM或Td作为受区血管。我们的主要结局是皮瓣存活率。我们使用JADAD和MINOR量表评估纳入研究的方法学质量。
在我们分析纳入的10篇文章中，共有1897例患者接受了2644次游离腹部皮瓣组织移植。有1项随机对照研究（Jadad评分为2/5）和9项非随机对照研究（MINORS评分为11 - 19/24）。在皮瓣丢失方面，两种血管的使用情况没有差异（1.18；95%可信区间0.71 - 1.95）。IM血管的并发症发生率在5%至12%之间，而Td血管的并发症发生率在3.4%至12%之间。血肿和血清肿发生率各不相同。在两项研究中，Td血管的脂肪坏死发生率更高。进行Td血管吻合术与手术时间较短和遇到不可用血管的风险较高相关。
在没有禁忌证的情况下，两种受区血管都是安全、可靠的，且结果相当。根据外科医生的偏好或特定临床情况，将其中任何一种作为一线血管使用都是合理的。
治疗性，证据级别：III。
