Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery of the University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Aesthetic Plast Surg. 2021 Aug;45(4):1431-1440. doi: 10.1007/s00266-020-02117-y. Epub 2021 Jan 22.
BACKGROUND: The aesthetic and functional outcomes of the donor site following abdominal-based free flap breast reconstruction have been suboptimal. The objective of this study is to evaluate a modified liposuction-assisted abdominoplasty technique combined with rectus plication (LPARSP) adopted from cosmetic abdominoplasty practice. PATIENTS AND METHODS: All abdominal-based free flap breast reconstructions from 01/2017 to 03/2019 were reviewed. Patients with central fullness and sufficient tissue surplus on the abdomen, thighs and flanks who received LPARSP and rectus plication were identified (LPARSP group) and matched for age and body mass index with patients who underwent conventional abdominoplasty (CA group). Abdominal skin sensation, objective functional and aesthetic measures of the abdomen, as well as patient-reported outcomes (Breast-Q), were analyzed. RESULTS: A total of 28 patients were included. Groups were similar in demographics. The mean amount of lipoaspirate in the LPARSP group was 1054±613.5 ml. The postoperative course was similar in both groups. The LPARSP technique resulted in a lower positioned horizontal scar (p = 0.03). The aesthetic outcome was superior in the LPARSP group (p < 0.0001). Furthermore, the LPARSP group presented with a decreased bulging rate (p = 0.05), and secondary refinement procedures were less frequently demanded (p = 0.02). In addition, the abdominal wall sensation of the flanks was improved in the LPARSP group (p = 0.05), whereby patient-reported outcome measures did not differ between groups. CONCLUSIONS: Lipoabdominoplasty with rectus plication represents a safe approach for donor-site closure in selected patients undergoing abdominal-based free flap breast reconstruction. Superior functional and aesthetic results paired with improved abdominal wall sensation are achieved compared to CA. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
背景：腹部游离皮瓣乳房重建术后供区的美学和功能效果并不理想。本研究的目的是评估一种改良的吸脂辅助腹成形术联合腹直肌折叠术（LPARSP），该技术来自于美容腹成形术的实践。
患者和方法：回顾了 2017 年 1 月至 2019 年 3 月期间所有的腹部游离皮瓣乳房重建术。选择接受 LPARSP 和腹直肌折叠术（LPARSP 组）的腹部中部饱满且腹部、大腿和侧腹部有足够组织余量的患者，并与接受传统腹成形术（CA 组）的患者进行年龄和体重指数匹配。分析腹部皮肤感觉、腹部客观功能和美学指标以及患者报告的结果（乳房质量问卷，Breast-Q）。
结果：共纳入 28 例患者。两组患者的人口统计学特征相似。LPARSP 组的平均吸脂量为 1054±613.5ml。两组的术后过程相似。LPARSP 技术可使水平切口位置更低（p=0.03）。LPARSP 组的美学效果更优（p<0.0001）。此外，LPARSP 组的膨隆率降低（p=0.05），需要二次整形的比例也降低（p=0.02）。此外，LPARSP 组侧腹部腹壁感觉改善（p=0.05），两组患者报告的结果无差异。
结论：对于接受腹部游离皮瓣乳房重建术的特定患者，腹直肌折叠的吸脂腹成形术是一种安全的供区关闭方法。与 CA 相比，该方法可获得更好的功能和美学效果，同时改善腹壁感觉。
证据等级 IV：本杂志要求作者为每篇文章分配一个证据等级。有关这些循证医学等级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
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