Butler Daniel P, Plonczak Agata M, Reissis Dimitris, Henry Francis P, Hunter Judith E, Wood Simon H, Jallali Navid
a Department of Plastic and Reconstructive Surgery , Imperial College Hospital NHS Trust , London , UK.
J Plast Surg Hand Surg. 2018 Dec;52(6):338-342. doi: 10.1080/2000656X.2018.1498790. Epub 2018 Sep 4.
Deep inferior epigastric artery perforator (DIEP) flap has become the gold standard in autologous breast reconstruction. Attention is now being focused on the impact of DIEP flap harvest technique on abdominal hernia rates. The aim of this study was to evaluate DIEP abdominal wall morbidity in relation to flap harvest and fascial closure technique. A retrospective analysis of patients undergoing DIEP flap breast reconstruction between 2012 and 2016 was performed. Post-operative evaluation of the abdominal wall integrity was performed by an operating consultant. The rectus fascia was closed using one of three techniques. The study included 202 patients, in whom 234 DIEP flaps were performed. Eight patients (3.4%) developed a clinically evident abdominal bulge post-operatively and one (0.5%) had a hernia. Harvesting two or more perforators was more likely to result in post-operative abdominal hernia/bulge than taking a single perforator ( = .032). Using a perforator from the lateral row or both rows was more likely to result in a hernia/bulge than if a single medial perforator was harvested ( = .026). Comparison of the rectus fascia closure technique did not show any statistically significant difference in abdominal wall morbidity. Consideration should be given towards perforator selection when harvesting a DIEP flap. Where appropriate, a suitable single medial row perforator with a favourable suprafascial course should be chosen. This study has not shown mesh-free fascial closure to be inferior to mesh-supported closure. Careful consideration to the role of synthetic mesh within this patient cohort should be given.
腹壁下深动脉穿支（DIEP）皮瓣已成为自体乳房重建的金标准。目前，人们的注意力集中在DIEP皮瓣切取技术对腹部疝发生率的影响上。本研究的目的是评估与皮瓣切取和筋膜关闭技术相关的DIEP腹壁并发症。对2012年至2016年间接受DIEP皮瓣乳房重建的患者进行了回顾性分析。由手术顾问对腹壁完整性进行术后评估。腹直肌筋膜采用三种技术之一进行关闭。该研究纳入了202例患者，共进行了234例DIEP皮瓣手术。8例患者（3.4%）术后出现临床上明显的腹部膨隆，1例（0.5%）发生疝。切取两个或更多穿支比切取单个穿支更易导致术后腹部疝/膨隆（P = 0.032）。与切取单个内侧穿支相比，切取外侧排或两排的穿支更易导致疝/膨隆（P = 0.026）。腹直肌筋膜关闭技术的比较在腹壁并发症方面未显示出任何统计学上的显著差异。切取DIEP皮瓣时应考虑穿支的选择。在合适的情况下，应选择走行于筋膜上且合适的单个内侧排穿支。本研究未表明无网片筋膜关闭不如有网片支撑的关闭。应仔细考虑合成网片在该患者群体中的作用。
