Homsy Christopher, Theunissen Taylor, Sadeghi Alireza
From the Department of Surgery, Division of Plastic Surgery, Tufts Medical Center; Theunissen Aesthetic Plastic Surgery; and Sadeghi Center for Plastic Surgery.
Plast Reconstr Surg. 2022 Oct 1;150(4):755-761. doi: 10.1097/PRS.0000000000009576. Epub 2022 Jul 22.
Perforator flap use in breast cancer reconstruction has evolved significantly in the last decade. The authors reviewed their experience and evaluated thoracodorsal artery perforator (TDAP) flap outcomes in breast reconstruction.
A retrospective chart review was conducted of all women undergoing breast reconstruction between 2012 and 2018. Included were patients who underwent a mastectomy (unilateral or bilateral) with immediate reconstruction or requiring a revision reconstruction with a TDAP flap. Reconstruction for nonmalignant causes were excluded. Patient demographics, risk factors, indications, operative details, and complications were reviewed. Major (partial or total flap necrosis, hematoma, and wound breakdown requiring operative management) and minor (cellulitis, seroma, and minor wound breakdown managed with local wound care) complications were recorded.
A total of 138 charts were reviewed for the years 2012 and 2018, and 126 patients met inclusion criteria. Mean patient age was 52.1 years. Mean patient body mass index was 29.1 kg/m 2 . A total of 174 TDAP flaps were performed. The success rate was 98.3 percent. There were three flap losses (all partial). Operable fat necrosis rate was 3 percent. Donor-site morbidity was low at a rate of 1.2 percent. There was no difference in complications between patients who had a history of radiation therapy and those who did not (16.7 and 18.6 percent, respectively; p = 0.829).
This study is the largest series in the literature that highlights the utility of the TDAP flap in breast reconstruction. This flap is a powerful tool that should be considered in patients for whom other reconstructive options have been exhausted or unavailable.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在过去十年中，穿支皮瓣在乳腺癌重建中的应用有了显著发展。作者回顾了他们的经验，并评估了胸背动脉穿支（TDAP）皮瓣在乳房重建中的效果。
对2012年至2018年间所有接受乳房重建的女性进行回顾性病历审查。纳入的患者包括接受乳房切除术（单侧或双侧）并立即进行重建或需要使用TDAP皮瓣进行修复重建的患者。排除因非恶性原因进行的重建。审查患者的人口统计学、危险因素、适应症、手术细节和并发症。记录主要并发症（部分或全部皮瓣坏死、血肿以及需要手术处理的伤口裂开）和次要并发症（蜂窝织炎、血清肿以及通过局部伤口护理处理的轻微伤口裂开）。
2012年至2018年共审查了138份病历，126例患者符合纳入标准。患者平均年龄为52.1岁。患者平均体重指数为29.1kg/m²。共进行了174例TDAP皮瓣手术。成功率为98.3%。有3例皮瓣丢失（均为部分丢失）。可手术处理的脂肪坏死率为3%。供区发病率较低，为1.2%。有放疗史和无放疗史的患者并发症发生率无差异（分别为16.7%和18.6%；p = 0.829）。
本研究是文献中最大的系列研究，突出了TDAP皮瓣在乳房重建中的实用性。该皮瓣是一种强大的工具，对于其他重建选择已用尽或不可用的患者应予以考虑。
临床问题/证据水平：治疗性，IV级。
