From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Plast Reconstr Surg. 2018 Aug;142(2):319-329. doi: 10.1097/PRS.0000000000004549.
The present study aimed to evaluate the influence of vertical location and spacing of perforators within flaps on the outcomes of deep inferior epigastric perforator (DIEP) flap breast reconstruction.
Patients who underwent unilateral breast reconstruction with unipedicle DIEP flaps were identified. They were categorized into cohorts based on the entry of perforators in the middle third (cohort 1), upper third (cohort 2), and multiple third parts (cohort 3) of the flaps. Perfusion-related complications including fat necrosis diagnosed with ultrasound and donor-site morbidity were compared between the cohorts.
A total of 287 patients were analyzed, including 51 in cohort 1, 75 in cohort 2, and 161 in cohort 3. The cohorts were well matched, except for a greater number of perforators and more frequent harvest of both medial and lateral row perforators in cohort 3. Rates of overall perfusion-related complications and fat necrosis differed significantly between cohorts, with the highest rates in cohort 2. Fat necrosis occurred predominantly in the caudal portion of the flap in cohort 2, whereas it was relatively evenly distributed in the cephalic and caudal portions in cohorts 1 and 3. Rates of donor-site complications were similar across the cohorts. Multivariate analyses demonstrated that vertical spacing of perforators had an independent influence on developing perfusion-related complications and fat necrosis, showing that cohort 2 had significantly higher odds compared with cohorts 1 and 3, respectively.
Vertical spacing of perforators might affect the risk of perfusion-related complications in DIEP flap breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在评估皮瓣穿支血管的垂直位置和间距对腹壁下动脉穿支皮瓣（DIEP）乳房再造结果的影响。
确定了接受单侧 DIEP 皮瓣乳房再造的患者。根据皮瓣中穿支血管进入中部（队列 1）、上部（队列 2）和多个中部分（队列 3），将他们分为不同队列。比较了各组之间与灌注相关的并发症（包括超声诊断的脂肪坏死）和供区并发症。
共分析了 287 例患者，其中队列 1 51 例，队列 2 75 例，队列 3 161 例。除了队列 3 中穿支血管数量更多且更频繁地采集内侧和外侧排穿支血管外，各组之间匹配良好。总的灌注相关并发症和脂肪坏死发生率在各组之间存在显著差异，其中队列 2 发生率最高。脂肪坏死主要发生在队列 2 皮瓣的尾部，而在队列 1 和 3 中则相对均匀地分布在头部和尾部。供区并发症的发生率在各组之间相似。多变量分析表明，穿支血管的垂直间距对发生灌注相关并发症和脂肪坏死有独立影响，表明队列 2 与队列 1 和 3 相比，发生的可能性显著更高。
穿支血管的垂直间距可能会影响 DIEP 皮瓣乳房再造中与灌注相关的并发症的风险。
临床问题/证据水平：治疗性，III 级。
