Leon Daniel Sotelo, Nazerali Rahim, Lee Gordon Kwanlyp
From the Department of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA.
Ann Plast Surg. 2018 May;80(5S Suppl 5):S295-S298. doi: 10.1097/SAP.0000000000001468.
Abdominal wall integrity may be compromised after abdominal flap harvest for breast reconstruction, leading to bulging or herniation due to weakening of the abdominal wall and dissection through the rectus muscle. Mesh can be used to reinforce the abdominal wall to reduce the risk of hernia formation postoperatively, especially in patients who may be at high risk. In this study, we describe this institution's experience with the use of mesh in the abdominal wall and critically evaluate its impact on patient outcomes and complications.
We retrospectively reviewed all patients with an abdominal free flap harvested for breast reconstruction at Stanford Health Care from 2005 to 2015. Multivariate-adjusted logistic regression analysis was used to compare the odds of abdominal complications-infection, bulging, and herniation-between patients with and without an abdominal mesh implanted during breast reconstruction.
Three hundred eighty patients met inclusion criteria. One hundred sixty-one patients received mesh, whereas 219 received no reinforcement. In the mesh group, there were 7 (4.3%) cases of postoperative abdominal bulging, 11 (6.8%) cases of abdominal infection, and no (0.0%) cases of herniation. In the group without mesh, there were 17 (7.8%) cases of abdominal bulging, 11 (5.0%) cases of abdominal infection, and 5 (2.3%) cases of herniation. There was a significant difference in the odds of bulging (odds ratio [OR], 0.30; P = 0.01). There was not a significant difference in the odds of herniation (OR, 2.26E-10; P = 0.99) or infection (OR, 1.21; P = 0.69).
In our current treatment algorithm, patients who received mesh were selected based upon several criteria, including obesity, weak fascia identified during surgery, and extensive muscle dissection. We confirm that the risk of bulging and herniation is decreased in patients receiving mesh. Furthermore, the risk of wound infection was not associated with the use of mesh; instead, a patient's elevated body mass index, as well as tension of closure, and other comorbidities are more likely causes of superficial wound complications. We find the use of mesh to be safe and beneficial in select patients undergoing abdominal free flap breast reconstruction who are at risk for hernias and bulges.
用于乳房重建的腹部皮瓣切取后，腹壁完整性可能受到损害，由于腹壁薄弱和经腹直肌解剖，可导致腹壁膨出或疝形成。补片可用于加强腹壁，以降低术后疝形成的风险，尤其是对于可能处于高风险的患者。在本研究中，我们描述了本机构使用补片修复腹壁的经验，并严格评估其对患者预后和并发症的影响。
我们回顾性分析了2005年至2015年在斯坦福医疗保健中心接受腹部游离皮瓣乳房重建的所有患者。采用多变量调整逻辑回归分析，比较乳房重建期间植入或未植入腹部补片患者发生腹部并发症（感染、膨出和疝）的几率。
380例患者符合纳入标准。161例患者接受了补片，而219例未接受加强修复。在补片组中，有7例（4.3%）术后出现腹壁膨出，11例（6.8%）发生腹部感染，无（0.0%）疝形成病例。在未使用补片组中，有17例（7.8%）腹壁膨出，11例（5.0%）腹部感染，5例（2.3%）疝形成。膨出几率有显著差异（优势比[OR]，0.30；P = 0.01）。疝形成几率（OR，2.26E - 10；P = 0.99）或感染几率（OR，1.21；P = 0.69）无显著差异。
在我们目前的治疗方案中，接受补片治疗的患者是根据几个标准选择的，包括肥胖、手术中发现的筋膜薄弱以及广泛的肌肉解剖。我们证实，接受补片治疗的患者腹壁膨出和疝形成的风险降低。此外，伤口感染风险与补片的使用无关；相反，患者体重指数升高、缝合张力以及其他合并症更可能是浅表伤口并发症的原因。我们发现，对于有疝和膨出风险的接受腹部游离皮瓣乳房重建的特定患者，使用补片是安全且有益的。
