Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo - ASST Monza, Monza, Italy.
Plastic Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.
J Reconstr Microsurg. 2022 Jul;38(6):451-459. doi: 10.1055/s-0041-1735508. Epub 2021 Sep 7.
In breast surgery, an autologous flap combined with implant may reduce the risk or repair the soft-tissue defects in several cases. Traditionally, the preferred flap is the myocutaneous latissimus dorsi (LD) flap. In the perforator flap era, the evolution of LD flap is the thoracodorsal artery perforator (TDAP) flap. The aim of this study is the comparison between LD flap and TDAP flap with implants in terms of early complications and shoulder function.
We performed a retrospective cohort study in accordance with the STROBE guidelines. Between January 1 2015 and January 1 2020, 27 women underwent a unilateral total breast reconstruction with LD or TDAP flap combined with an implant at our institution. 15 women were operated with LD flap and 12 with TDAP flap. The most frequent indications for intervention were results of mastectomy and radiation-induced contracture. We evaluated several data in terms of clinical and demographical characteristics, operative and perioperative factors, and follow-up variables. We assessed shoulder function through the Disability of the Arm, Shoulder and Hand Questionnaire (DASH).
The rate of complications was significantly lower in the TDAP group compared with the LD group (16.7% vs 60.0%, = 0.047. Table 3). Although the small sample size limited further detailed statistical analyses, we particularly noticed no cases of donor site seroma in the TDAP group, as compared with four in the LD group. Patients in the TDAP group had an ∼11-point lower mean DASH score compared with the LD group (9.8 vs 20.5). This difference was statistically significant ( = 0.049).
TDAP flap seems to be a reliable technique for soft-tissue coverage in total breast reconstruction with implants. In comparison with the traditional LD flap, it could be a more favorable option in terms of less complications and better quality of life.
在乳腺癌手术中，自体皮瓣联合植入物可降低多种情况下的软组织缺损风险或修复软组织缺损。传统上，首选的皮瓣是胸背肌皮瓣（Latissimus dorsi，LD）。在穿支皮瓣时代，LD 皮瓣的发展是胸背动脉穿支（Thoracodorsal artery perforator，TDAP）皮瓣。本研究旨在比较 LD 皮瓣和 TDAP 皮瓣联合植入物在早期并发症和肩部功能方面的差异。
我们按照 STROBE 指南进行了回顾性队列研究。2015 年 1 月 1 日至 2020 年 1 月 1 日期间，我院对 27 例女性单侧全乳重建患者进行了手术，其中 15 例患者采用 LD 皮瓣，12 例患者采用 TDAP 皮瓣。最常见的干预指征是乳房切除术和放射治疗后导致的挛缩。我们评估了临床和人口统计学特征、手术和围手术期因素以及随访变量等数据。我们通过手臂、肩部和手残疾问卷（Disability of the Arm, Shoulder and Hand Questionnaire，DASH）评估了肩部功能。
TDAP 组的并发症发生率明显低于 LD 组（16.7%比 60.0%， = 0.047。表 3）。尽管小样本量限制了进一步的详细统计学分析，但我们特别注意到 TDAP 组中没有供区血清肿病例，而 LD 组中有 4 例。TDAP 组的平均 DASH 评分比 LD 组低约 11 分（9.8 比 20.5）。这一差异具有统计学意义（ = 0.049）。
TDAP 皮瓣在全乳重建中联合植入物用于软组织覆盖似乎是一种可靠的技术。与传统的 LD 皮瓣相比，在减少并发症和提高生活质量方面，它可能是一种更有利的选择。
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