Kraft Casey T, Molina Bianca J, Skoracki Roman J
Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA.
Plast Surg (Oakv). 2021 Feb;29(1):16-20. doi: 10.1177/2292550320936683. Epub 2020 Jul 20.
Abdominal wall morbidity after microsurgical breast reconstruction is an important consideration for patients and surgeons. Previous studies are limited by multiple mesh locations or types. In this study, we evaluate specifically subfascial polypropylene mesh placement to determine a more definitive complication rate and basis for objective comparison.
A retrospective review was performed for patients undergoing microsurgical breast reconstruction at our institution by 3 surgeons from 2015 to 2018. All patients with sublay placement of polypropylene mesh were included. Patient demographics, medical comorbidities, type of reconstruction, and postoperative abdominal wall complications were recorded.
A total of 114 flaps were performed on 81 patients who met the inclusion criteria. Of these, 48 were deep inferior epigastric artery (DIEP) flaps (42%), 43 were MS-2 TRAM flaps (37.8%), 20 were muscle sparing (MS-1) transverse rectus abdominus muscle (TRAM) flaps (17.5%), and 3 were free TRAM flaps (2.6%). Average follow-up was 392 days (range: 29-1191). Average body mass index was 30.7. No patients developed hernias. Two patients (2.5%) complained of post-operative bulges, neither of which required operative treatment. Two patients experienced superficial abdominal wall infection, one of which required admission and intravenous antibiotics. Ten patients (12.3%) had abdominal incision dehiscence, 3 of which required operative intervention. There were no cases of mesh exposure, contamination, or removal.
Polypropylene mesh is safe and effective, with subfascial placement resulting in low morbidity and low rates of bulge/hernia formation after microsurgical breast reconstruction. Consideration should be given to using polypropylene mesh for fascial repairs after microsurgical breast reconstruction, particularly in high-risk populations.
显微外科乳房重建术后腹壁并发症是患者和外科医生需要重点关注的问题。以往的研究因多种补片放置位置或类型而受到限制。在本研究中，我们专门评估了筋膜下聚丙烯补片的放置情况，以确定更确切的并发症发生率，并为客观比较提供依据。
对2015年至2018年在我院由3名外科医生进行显微外科乳房重建的患者进行回顾性研究。纳入所有采用聚丙烯补片下层放置的患者。记录患者的人口统计学资料、内科合并症、重建类型和术后腹壁并发症。
共有81例符合纳入标准的患者接受了114次皮瓣手术。其中，48例为腹壁下深动脉（DIEP）皮瓣（42%），43例为MS-2横行腹直肌肌皮瓣（TRAM）（37.8%），20例为保留肌肉（MS-1）的横行腹直肌肌皮瓣（17.5%），3例为游离TRAM皮瓣（2.6%）。平均随访392天（范围：29 - 1191天）。平均体重指数为30.7。无患者发生疝。2例患者（2.5%）主诉术后出现隆起，均无需手术治疗。2例患者发生浅表腹壁感染，其中1例需要住院并静脉使用抗生素。10例患者（12.3%）出现腹部切口裂开，其中3例需要手术干预。无补片暴露、污染或取出的病例。
聚丙烯补片安全有效，筋膜下放置导致显微外科乳房重建术后发病率低，隆起/疝形成率低。对于显微外科乳房重建术后的筋膜修复，应考虑使用聚丙烯补片，尤其是在高危人群中。
