腹部皮瓣乳房重建术后的并发症和患者报告结局：乳房切除术重建结局研究联盟的研究结果。
Complications and Patient-Reported Outcomes after Abdominally Based Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study.
机构信息
Boston, Mass.; Ann Arbor, Mich.; and New York, N.Y.
From the Division of Plastic Surgery, Brigham and Women's Hospital; the Section of Plastic Surgery and the Department of Biostatistics, University of Michigan Medical School; and Memorial Sloan Kettering Cancer Center.
出版信息
Plast Reconstr Surg. 2018 Feb;141(2):271-281. doi: 10.1097/PRS.0000000000004016.
BACKGROUND
Abdominal flap reconstruction is the most popular form of autologous breast reconstruction. The current study compared complications and patient-reported outcomes after pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) flaps.
METHODS
Patients undergoing abdominally based breast reconstruction at 11 centers were prospectively evaluated for abdominal donor-site and breast complications. Patient-reported outcomes were measured by the BREAST-Q and Patient-Reported Outcomes Measurement Information System surveys. Mixed-effects regression models were used to assess the effects of procedure type on outcomes.
RESULTS
Seven hundred twenty patients had 1-year follow-up and 587 had 2-year follow-up. Two years after reconstruction, SIEA compared with DIEP flaps were associated with a higher rate of donor-site complications (OR, 2.7; p = 0.001); however, SIEA flaps were associated with higher BREAST-Q abdominal physical well-being scores compared with DIEP flaps at 1 year (mean difference, 4.72, on a scale from 0 to 100; p = 0.053). This difference was not significant at 2 years. Abdominal physical well-being scores at 2 years postoperatively were lower in the pedicled TRAM flap group by 7.2 points (p = 0.006) compared with DIEP flaps and by 7.8 points (p = 0.03) compared with SIEA flaps, and in the free TRAM flap group, scores were lower by 4.9 points (p = 0.04) compared with DIEP flaps. Bilateral reconstruction had significantly lower abdominal physical well-being scores compared with unilateral reconstruction.
CONCLUSIONS
Although all abdominally based flaps are viable breast reconstruction options, DIEP and SIEA flaps are associated with higher abdominal physical well-being than pedicled and free TRAM flaps. Although SIEA flaps offer the advantage of not violating the fascia, higher rates of donor-site complications may diminish patient satisfaction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
背景
腹部皮瓣重建是自体乳房重建最流行的形式。本研究比较了带蒂横直肌腹皮瓣（TRAM）、游离 TRAM、腹壁下动脉穿支皮瓣（DIEP）和腹壁浅动脉皮瓣（SIEA）后并发症和患者报告的结果。
方法
在 11 个中心接受腹部乳房重建的患者前瞻性评估腹部供区和乳房并发症。通过 BREAST-Q 和患者报告的结果测量信息系统调查评估患者报告的结果。混合效应回归模型用于评估手术类型对结果的影响。
结果
720 例患者有 1 年随访，587 例有 2 年随访。重建后 2 年，SIEA 皮瓣与 DIEP 皮瓣相比，供区并发症发生率更高（OR，2.7；p = 0.001）；然而，与 DIEP 皮瓣相比，SIEA 皮瓣在 1 年时的 BREAST-Q 腹部生理健康评分更高（平均差异为 4.72，评分范围为 0 至 100；p = 0.053）。2 年时差异无统计学意义。与 DIEP 皮瓣相比，带蒂 TRAM 皮瓣组患者的腹部生理健康评分在术后 2 年时降低了 7.2 分（p = 0.006），与 SIEA 皮瓣相比降低了 7.8 分（p = 0.03），游离 TRAM 皮瓣组患者的评分降低了 4.9 分（p = 0.04）。双侧重建的腹部生理健康评分明显低于单侧重建。
结论
尽管所有腹部皮瓣都是可行的乳房重建选择，但与带蒂和游离 TRAM 皮瓣相比，DIEP 和 SIEA 皮瓣与更高的腹部生理健康相关。尽管 SIEA 皮瓣具有不侵犯筋膜的优势，但更高的供区并发症发生率可能会降低患者的满意度。
临床问题/证据水平：治疗性，II 级。
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