Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, 4th Floor, Dallas, TX, United States.
Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, 4th Floor, Dallas, TX, United States.
J Plast Reconstr Aesthet Surg. 2021 Sep;74(9):2194-2201. doi: 10.1016/j.bjps.2020.12.044. Epub 2020 Dec 26.
This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Abdominal wall morbidities are categorized, and an algorithm for management is provided.
A retrospective review of 644 patients who underwent abdominal based flap breast reconstruction between 2009 and 2018 and met selection criteria was performed. Bulge and hernia were evaluated on exam and then by imaging and/or operative exploration. The incidence of abdominal weakness was evaluated by BREAST-Q™ data. Risk factors were analyzed.
Of the 644 patients, 23 (3.6%) had a clinically significant bulge or hernia on exam postoperatively. Developing an abdominal wound postoperatively and sacrificing nerves both correlated with an increased incidence of bulge or hernia (p < 0.05). The use of lateral row perforators, keeping the umbilicus, higher BMI, and the use of biological mesh in the initial abdominal wall repair trended toward an increased incidence of bulge or hernia; however, these data were not statistically significant. Seven percent of patients who answered the BREAST-Q™ reported abdominal weakness. Patients in the umbilicus sacrificing cohort had an increased incidence of weakness (p < 0.05). Abdominal wounds, nerve sacrificing procedures and obesity correlated with an increased incidence of weakness; these data were not statistically significant.
A classification and algorithm for treatment of functional abdominal wall morbidity after DIEP flap is provided. Abdominal wall morbidity is classified as: type 1 - abdominal weakness; type 2 - smaller, unilateral abdominal bulge; and type 3 - true abdominal hernia or large bilateral bulge. An algorithm of treatment is presented, which includes physical therapy and surgical repair recommendations.
本研究分析了腹壁薄弱、疝和膨出在腹壁下动脉穿支皮瓣（DIEP）乳房重建后的表现。对腹壁并发症进行分类，并提供了一种管理方法。
回顾性分析了 2009 年至 2018 年间接受腹部皮瓣乳房重建且符合选择标准的 644 例患者。通过体格检查、影像学检查和/或手术探查评估膨出和疝。通过 BREAST-Q™数据评估腹壁无力的发生率。分析了风险因素。
在 644 例患者中，术后体格检查发现 23 例（3.6%）有明显的膨出或疝。术后腹部伤口和神经牺牲都与膨出或疝的发生率增加相关（p<0.05）。使用侧支穿支血管、保留脐部、较高的 BMI 和在初始腹壁修复中使用生物补片与膨出或疝的发生率增加有关，但这些数据没有统计学意义。在回答 BREAST-Q™的 7%的患者中报告有腹壁无力。在牺牲脐部的患者中，无力的发生率增加（p<0.05）。腹部伤口、神经牺牲手术和肥胖与无力的发生率增加有关，但这些数据没有统计学意义。
提供了一种 DIEP 皮瓣后功能性腹壁并发症的分类和治疗方法。腹壁并发症分为：1 型 - 腹壁无力；2 型 - 较小的单侧腹部膨出；3 型 - 真性腹壁疝或大的双侧膨出。提出了一种治疗方案，包括物理治疗和手术修复建议。
