Elver Ashlie A, Matthews Stephanie A, Egan Katie G, Bowles Eva L, Nazir Niaman, Flurry Mitchell, Holding Julie, Lai Eric C, Butterworth James A
Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas.
J Reconstr Microsurg. 2023 Jan;39(1):20-26. doi: 10.1055/s-0042-1744310. Epub 2022 Apr 27.
Perforators are typically found in rows in the deep inferior epigastric perforator (DIEP) flap. As methods to assess flap perfusion continue to improve, surgeons may be more likely to select perforators traditionally avoided. The purpose of this article is to describe clinical outcomes based on row and number of perforators to reevaluate flap and abdominal donor site morbidity.
A retrospective analysis was performed on patients who underwent breast reconstruction with DIEP flaps by four microsurgeons from 2013 to 2020. The row and number of perforators were determined from operative reports. Chi-square and -test or nonparametric Fisher's exact test and Wilcoxon two-sample test were used for discrete and continuous variable, respectively, as applicable. Logistic regression was used for multivariable analyses.
Of 628 flaps, 305 were medial row (58.7%), 159 were lateral row (30.6%), and 55 had both rows (10.6%). Partial flap loss was higher in both rows ( = 0.003). Fat necrosis was higher with medial ( = 0.03) and both rows ( = 0.01) when compared with lateral using multivariable analysis. Hernia or bulge was higher in lateral row flaps (lateral: 8/157, 5.1%; medial, 5/299, 1.7%; both, 0/55; = 0.05); however, mesh was more commonly used in both row flaps ( = 0.05). There was no difference in fat necrosis or abdominal morbidity between single and multiple perforators.
There was no difference in fat necrosis based on the number or row of perforators. The lateral row provides adequate perfusion but may be associated with an elevated risk of hernia or bulge. Patients may benefit from mesh, especially when both rows are dissected.
穿支血管通常成排存在于腹壁下深动脉穿支（DIEP）皮瓣中。随着评估皮瓣灌注方法的不断改进，外科医生可能更倾向于选择传统上被避免的穿支血管。本文旨在描述基于穿支血管排数和数量的临床结果，以重新评估皮瓣和腹部供区的并发症。
对2013年至2020年由四位显微外科医生采用DIEP皮瓣进行乳房重建的患者进行回顾性分析。穿支血管的排数和数量从手术报告中确定。分别根据情况对离散变量和连续变量使用卡方检验和t检验或非参数费舍尔精确检验以及威尔科克森两样本检验。采用逻辑回归进行多变量分析。
在628例皮瓣中，305例为内侧排（58.7%），159例为外侧排（30.6%），55例为两排均有（10.6%）。两排均有的皮瓣部分皮瓣坏死发生率更高（P = 0.003）。多变量分析显示，与外侧排相比，内侧排（P = 0.03）和两排均有（P = 0.01）时脂肪坏死发生率更高。外侧排皮瓣的疝或隆起发生率更高（外侧：8/157，5.1%；内侧：5/299，1.7%；两排均有：0/（此处原文有误，推测为0/55）；P = 0.05）；然而，两排均有的皮瓣更常使用补片（P = 0.05）。单穿支血管和多穿支血管之间的脂肪坏死或腹部并发症无差异。
基于穿支血管的数量或排数，脂肪坏死无差异。外侧排提供足够的灌注，但可能与疝或隆起的风险升高有关。患者可能从补片中获益，尤其是在解剖两排穿支血管时。
