Department of Surgery, Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Reconstr Microsurg. 2021 Sep;37(7):566-579. doi: 10.1055/s-0041-1723816. Epub 2021 Mar 1.
Approximately half of all patients presenting for autologous breast reconstruction have abdominal scars from prior surgery, the presence of which is considered by some a relative contraindication for abdominally based reconstruction. This meta-analysis examines the impact of prior abdominal surgery on the complication profile of breast reconstruction with abdominally based free tissue transfer.
Literature search was conducted using PubMed, Scopus, and Web of Science. Included studies examined patients with a history of prior abdominal surgery who then underwent abdominally based free flap breast reconstruction. Prior liposuction patients and those with atypical flap designs were excluded. The Newcastle-Ottawa Scale was used to assess study quality. Flap complications included total and partial flap loss, fat necrosis, infection, and reoperation. Donor-site complications included delayed wound healing, infection, seroma, hematoma, and abdominal wall morbidity (hernia, bulge, laxity). Relative risk and 95% confidence intervals (CIs) between groups were calculated. Forest plots, statistic heterogeneity assessments, and publication bias funnel plots were produced. Publication bias was corrected with a trim-and-fill protocol. Overall effects were assessed by fixed-effects and random-effects models.
After inclusion and exclusion criteria were applied, 16 articles were included for final review. These included 14 cohort and 2 case-control studies, with 1,656 (46.3%) patients and 2,236 (48.5%) flaps having undergone prior surgery. Meta-analysis showed patients with prior abdominal surgery were significantly more likely to experience donor-site delayed wound healing with a risk ratio of 1.27 (random 95% CI [1.00; 1.61]; = 4) after adjustment for publication bias. No other complications were statistically different between groups.
In patients with a history of prior abdominal surgery, abdominally based free tissue transfer is a safe and reliable option. Abdominal scars may slightly increase the risk of delayed donor-site wound healing, which can aid the surgeon in preoperative counseling.
大约一半的接受自体乳房重建的患者有腹部手术疤痕，一些人认为这是腹部皮瓣重建的相对禁忌症。本荟萃分析检查了既往腹部手术对腹部游离组织转移乳房重建并发症谱的影响。
使用 PubMed、Scopus 和 Web of Science 进行文献检索。纳入的研究检查了有腹部手术史的患者，然后进行了腹部游离皮瓣乳房重建。排除了既往抽脂患者和非典型皮瓣设计的患者。使用纽卡斯尔-渥太华量表评估研究质量。皮瓣并发症包括总皮瓣和部分皮瓣坏死、脂肪坏死、感染和再次手术。供区并发症包括延迟伤口愈合、感染、血清肿、血肿和腹壁病（疝、膨出、松弛）。计算组间相对风险和 95%置信区间（CI）。制作森林图、统计异质性评估和发表偏倚漏斗图。使用修剪和填充协议纠正发表偏倚。通过固定效应和随机效应模型评估总体效果。
应用纳入和排除标准后，最终有 16 篇文章进行了综述。这些研究包括 14 项队列研究和 2 项病例对照研究，共纳入 1656 例（46.3%）患者和 2236 例（48.5%）皮瓣接受了既往手术。荟萃分析显示，在调整发表偏倚后，既往腹部手术患者供区延迟伤口愈合的风险比为 1.27（随机 95%CI [1.00；1.61]； = 4）。两组间其他并发症无统计学差异。
对于有既往腹部手术史的患者，腹部游离组织转移是一种安全可靠的选择。腹部疤痕可能会略微增加供区延迟伤口愈合的风险，这可以帮助外科医生在术前咨询中。
