Santanelli di Pompeo Fabio, D'Orsi Gennaro, Firmani Guido, Paolini Guido, Renzi Luca Francesco, Sorotos Michail
Chair of Plastic Surgery, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3004-3013. doi: 10.1016/j.bjps.2022.06.052. Epub 2022 Jun 20.
According to ASPS, 107,238 breast reconstructions (BR) have been performed in the United States this year. The latissimus dorsi (LD) flap is used for breast reconstruction (BR), either with an implant or an extended flap harvest. Implant-enhanced LD is associated with 50% reoperation rates. To avoid implant-related complications, we introduced the Fat-Augmented LD (FALD) flap. Several authors report 92% patient satisfaction and 36% complication rates (CR). The aim of our study is to present a single-center uncontrolled case series with long follow-up assessing CR and esthetic results. Women with small-to-moderate breasts requiring immediate or delayed BR were included, whereas athletic and paraplegic women or patients with contraindication for free flap BR were excluded. Clinical and surgical data were analyzed. Esthetic analysis was performed using a panel of independent observers. Between December 2010 and November 2019, 100 patients underwent 148 FALD-based BR. Average operative time was 193.5 min for unilateral procedure and 290.6 min for bilateral procedure. Mean immediate AFT volume was 105.3 cc (range 60-170) per breast. Major complication (total or partial flap necrosis > 30%) rate was 0%, and minor complication (partial flap necrosis < 30%, fat necrosis hematoma, seroma, donor site dehiscence, and chronic pain) rate was 6.76%. Esthetic analysis garnered satisfactory results for all types of mastectomies. For variables regarding skin texture (p = 0.001), scar location (p = 0.005), and total score (p = 0.001), patients undergoing Modified Radical Mastectomy scored lower than Skin-Sparing Mastectomy and Nipple-Sparing Mastectomy. We were able to confirm that the FALD flap is a safe with a low complication rate and high patient satisfaction. Level of Evidence IV.
根据美国整形外科学会（ASPS）的数据，今年美国共进行了107,238例乳房重建手术（BR）。背阔肌（LD）皮瓣用于乳房重建，可植入假体或扩大皮瓣切取范围。植入假体增强的LD皮瓣手术的再次手术率为50%。为避免与假体相关的并发症，我们引入了脂肪增强背阔肌（FALD）皮瓣。几位作者报告该皮瓣患者满意度为92%，并发症发生率（CR）为36%。我们研究的目的是呈现一个单中心非对照病例系列，进行长期随访以评估并发症发生率和美学效果。纳入了需要即刻或延迟乳房重建的中小乳房女性，而运动员和截瘫女性或有游离皮瓣乳房重建禁忌证的患者被排除。分析临床和手术数据。由一组独立观察者进行美学分析。2010年12月至2019年11月期间，100例患者接受了148例基于FALD皮瓣的乳房重建手术。单侧手术平均手术时间为193.5分钟，双侧手术为290.6分钟。每侧乳房即刻平均自体脂肪移植（AFT）体积为105.3立方厘米（范围60 - 170立方厘米）。主要并发症（皮瓣全部或部分坏死>30%）发生率为0%，次要并发症（皮瓣部分坏死<30%、脂肪坏死、血肿、血清肿、供区裂开和慢性疼痛）发生率为6.76%。美学分析对所有类型的乳房切除术均获得了满意结果。对于皮肤质地（p = 0.001）、瘢痕位置（p = 0.005）和总分（p = 0.001）等变量，改良根治性乳房切除术患者的得分低于保乳皮肤乳房切除术和保乳乳头乳房切除术。我们能够证实FALD皮瓣安全，并发症发生率低，患者满意度高。证据等级为IV级。
