Bond Evalina S, Soteropulos Carol E, Poore Samuel O
Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Arch Plast Surg. 2022 May 27;49(3):324-331. doi: 10.1055/s-0042-1748646. eCollection 2022 May.
Prior abdominal liposuction can be viewed as a relative or absolute contraindication to abdominally based autologous breast reconstruction given concerns for damaged perforators and scarring complicating intraoperative dissection. This systematic review aims to explore the outcomes of abdominally based breast reconstruction in patients with a history of abdominal liposuction. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature search was conducted using PubMed, Scopus, and Web of Science from the earliest available date through June 2020. Deep inferior epigastric perforator, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), superficial inferior epigastric artery, and pedicled TRAM flaps were included for evaluation. Complications included total or partial flap loss, fat necrosis, seroma, delayed wound healing, and donor site complications. After inclusion criteria were applied, 336 nonduplicate articles were screened, yielding 11 for final review, representing 55 flaps in 43 patients. There was no instance of total flap loss, eight (14.5%) flaps developed partial loss or fat necrosis, three (5.4%) flaps had delayed wound healing, and two (4.6%) patients had donor site complications. Most authors (8/11) utilized some type of preoperative imaging. Doppler ultrasonography was the most used modality, and these patients had the lowest rate of partial flap loss or flap fat necrosis (8%), followed by those without any preoperative imaging (10%). In conclusion, this review supports that patients undergoing abdominally based autologous breast reconstruction with a history of abdominal liposuction are not at an increased risk of flap or donor site complications. Although preoperative imaging was common, it did not reliably decrease complications. Further prospective studies are needed to address the role of imaging in improving outcomes.
鉴于对穿支血管受损和瘢痕形成会使术中解剖复杂化的担忧，既往腹部吸脂术可被视为基于腹部的自体乳房重建的相对或绝对禁忌证。本系统评价旨在探讨有腹部吸脂史的患者进行基于腹部的乳房重建的结果。使用PubMed、Scopus和Web of Science进行了一项遵循系统评价和Meta分析的首选报告项目指南的文献检索，检索时间从最早可用日期至2020年6月。纳入评估的有腹壁下深穿支皮瓣、保留肌肉的腹直肌肌皮瓣（TRAM）、腹壁下浅动脉皮瓣和带蒂TRAM皮瓣。并发症包括皮瓣全部或部分坏死、脂肪坏死、血清肿、伤口愈合延迟和供区并发症。应用纳入标准后，筛选出336篇不重复的文章，最终纳入11篇进行综述，代表43例患者的55个皮瓣。没有皮瓣完全坏死的情况，8个（14.5%）皮瓣出现部分坏死或脂肪坏死，3个（5.4%）皮瓣伤口愈合延迟，2例（4.6%）患者出现供区并发症。大多数作者（8/11）使用了某种类型 的术前影像学检查。多普勒超声是最常用的检查方式，这些患者的皮瓣部分坏死或皮瓣脂肪坏死发生率最低（8%），其次是未进行任何术前影像学检查的患者（10%）。总之，本综述支持有腹部吸脂史且接受基于腹部的自体乳房重建的患者，皮瓣或供区并发症风险并未增加。虽然术前影像学检查很常见，但并不能可靠地降低并发症发生率。需要进一步的前瞻性研究来探讨影像学检查在改善结局方面的作用。
