Heo Jae-Woo, Park Seong Oh, Jin Ung Sik
a Department of Plastic and Reconstructive Surgery , Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Republic of Korea.
b Department of Plastic and Reconstructive Surgery , Hanyang University Seoul Hospital , Seoul , Republic of Korea.
J Plast Surg Hand Surg. 2018 Dec;52(6):325-332. doi: 10.1080/2000656X.2018.1493389. Epub 2018 Jul 24.
Transverse rectus abdominis myocutaneous flap is one of the most commonly used reconstruction tools after oncological mastectomy. However, post-operative donor-site morbidities remain an issue to be addressed. In this study, we retrospectively reviewed patients with either immediate or delayed breast reconstruction using a free muscle-sparing type I transverse rectus abdominis myocutaneous flap only, performed by a single surgeon, regarding the donor-site morbidity. From January 2012 to July 2017, the study subjects summed up to 615 patients, in a single institution. Preoperative planning and actual surgical techniques were outlined including the evaluation of the location of the perforators using a three-dimensional abdominal computed tomography angiography scan, minimal fascia sacrifice, beveled dissection and minimization of the tension on the central abdomen during closure. During a 1-year follow-up, a total of 33 patients (5.4%) were complicated with any donor-site morbidity. Those in need of secondary revision on their donor-sites accounted for 23 patients (69.7%). No factor was found statistically significant to increase the risk of donor-site morbidity. Many surgical techniques have been devised for closure of the donor-site in transverse rectus abdominis myocutaneous flap patients. And, several factors have been proposed as increasing the risk of donor-site morbidity. Although all the suggested predictive factors failed to prove its significance on increasing the risk, a set of preoperative planning and surgical techniques employed in our study has proven to be both safe and efficient in lowering the postoperative donor-site morbidities.
腹直肌横形肌皮瓣是肿瘤性乳房切除术后最常用的重建工具之一。然而，术后供区并发症仍是一个有待解决的问题。在本研究中，我们回顾性分析了仅由一名外科医生使用保留肌肉的I型腹直肌横形肌皮瓣进行即刻或延迟乳房重建患者的供区并发症情况。2012年1月至2017年7月，在单一机构中，研究对象共计615例患者。概述了术前规划和实际手术技术，包括使用三维腹部计算机断层扫描血管造影评估穿支位置、尽量减少筋膜牺牲、斜行剥离以及在关闭时尽量减少中央腹部的张力。在1年的随访期间，共有33例患者（5.4%）出现任何供区并发症。需要对供区进行二次修复的患者有23例（69.7%）。未发现有统计学意义的增加供区并发症风险的因素。已经设计了许多手术技术用于腹直肌横形肌皮瓣患者供区的关闭。并且，已经提出了几个增加供区并发症风险的因素。尽管所有建议的预测因素均未能证明其对增加风险具有显著意义，但我们研究中采用的一套术前规划和手术技术已被证明在降低术后供区并发症方面既安全又有效。
