Issa Christopher J, Lu Stephen M, Boudiab Elizabeth M, DeSano Jeffrey, Sachanandani Neil S, Powers Jeremy M, Chaiyasate Kongkrit
Oakland University William Beaumont School of Medicine, Auburn Hills, Mich.
Division of Plastic and Reconstructive Surgery, UPMC Pinnacle, Mechanicsburg, Pa.
Plast Reconstr Surg Glob Open. 2021 Jun 7;9(6):e3608. doi: 10.1097/GOX.0000000000003608. eCollection 2021 Jun.
The deep inferior epigastric perforator flap for breast reconstruction is associated with lengthy operative times that remain an issue for plastic surgeons today. The main objective of this study was to determine if a 2-stage deep inferior epigastric perforator flap reconstruction resulted in a shorter total plastic surgeon operative time compared with an immediate reconstruction.
A retrospective chart review was conducted on all patients who underwent deep inferior epigastric perforator flap breast reconstruction from February 2013 to July 2020 by the senior author. Patient demographics, medical comorbidities, mastectomy characteristics, expander placement, reconstructive procedures, operative time, and complications were tabulated.
The study included a total of 128 patients. For immediate/1-stage flap reconstruction, average operative times for the plastic surgeon were 427.0 minutes for unilateral procedures, and 506.3 minutes for bilateral procedures. For delayed/2-stage reconstruction, average combined plastic surgeon operative times were 351.1 minutes for unilateral expander followed by flap reconstruction (75.9 minutes shorter than immediate unilateral, = 0.007), and 464.8 minutes for bilateral reconstruction (41.5 minutes shorter than immediate bilateral, = 0.04). Total patient time under anesthesia was longer for 2-staged bilateral reconstruction ( 0.0001), but did not differ significantly for unilateral reconstruction. Complications between immediate and delayed groups were not significantly different.
We found that staged reconstruction over 2 procedures resulted in a significant reduction in operative time for the plastic surgeon for both unilateral and bilateral reconstruction. With amenable breast surgeons and patients, the advantages of controlling scheduling and the operating room may encourage plastic surgeons to consider performing free flap reconstruction in a delayed fashion.
用于乳房重建的腹壁下深动脉穿支皮瓣手术时间较长，这在当今仍是整形外科医生面临的一个问题。本研究的主要目的是确定两阶段腹壁下深动脉穿支皮瓣重建与即刻重建相比，整形外科医生的总手术时间是否更短。
对2013年2月至2020年7月由资深作者进行腹壁下深动脉穿支皮瓣乳房重建的所有患者进行回顾性病历审查。将患者的人口统计学资料、合并症、乳房切除术特征、扩张器植入、重建手术、手术时间和并发症制成表格。
该研究共纳入128例患者。对于即刻/一期皮瓣重建，整形外科医生进行单侧手术的平均手术时间为427.0分钟，双侧手术为506.3分钟。对于延迟/两阶段重建，整形外科医生进行单侧扩张器植入后皮瓣重建的平均总手术时间为351.1分钟（比即刻单侧手术短75.9分钟，P = 0.007），双侧重建为464.8分钟（比即刻双侧手术短41.5分钟，P = 0.04）。两阶段双侧重建患者的总麻醉时间更长（P = 0.0001），但单侧重建无显著差异。即刻组和延迟组之间的并发症无显著差异。
我们发现，分两个步骤进行的分期重建显著缩短了整形外科医生进行单侧和双侧重建的手术时间。对于合适的乳腺外科医生和患者，控制手术安排和手术室的优势可能会促使整形外科医生考虑采用延迟方式进行游离皮瓣重建。
