单侧即刻腹壁下动脉穿支皮瓣乳房重建术在保留皮肤的乳房切除术：改善乳房对称性的修复手术比较研究。

Unilateral immediate deep inferior epigastric artery perforator flap breast reconstruction following skin sparing mastectomy: A comparative study on revision surgeries to improve breast symmetry.

机构信息

Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit, University of Cagliari, University Hospital Duilio Casula, Cagliari, Italy.

Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, University Hospital Campus Bio-Medico, Rome, Italy.

出版信息

Microsurgery. 2022 Nov;42(8):766-774. doi: 10.1002/micr.30945. Epub 2022 Aug 2.

DOI:10.1002/micr.30945

PMID:35916342

Abstract

BACKGROUND

The number of revision surgeries to improve breast asymmetry after deep inferior epigastric perforator (DIEP) flap breast reconstruction is still high worldwide with impact on both patients and healthcare systems. These procedures include fat grafting, contralateral breast symmetrization, scar revision, flap repositioning and remodeling. A previously published DIEP flap insetting algorithm has proven to be effective in selecting patient-tailored strategies to achieve excellent aesthetic outcomes. This study investigated whether this insetting algorithm was effective in reducing revision surgeries in patients undergoing SSM and immediate DIEP flap breast reconstruction to achieve the goal of a one-stage reconstruction.

METHODS

This retrospective case-control study included 60 patients (group A) treated without the DIEP flap standardized insetting algorithm and 60 patients (group B) treated with the standardized insetting algorithm, which considers among its variables the type of breast to be reconstructed, abdominal tissue thickness, rotation due to harvesting side. Demographic data, operative data, complications and number of revision surgeries were recorded.

RESULTS

One hundred and twenty primary and 106 revision surgeries were performed. Groups were homogenous for age (p = .32), body mass index (p = .77), flap weight (p = .7), operative time (p = .87) and early complications (p = .78). When excluding isolated nipple reconstruction from the revision surgeries, one-stage reconstruction was successfully performed in 26 patients in group A (43.3%) and 39 patients (65.0%) in group B, with a statistically significant difference between the groups (p = .003).

CONCLUSIONS

The introduction of a standardized insetting algorithm for immediate unilateral DIEP flap breast reconstruction can be effective in reducing the number of revision surgeries for breast asymmetry, making a one-stage reconstruction an achievable and reliable target.

摘要

背景

在全球范围内，通过深部腹壁下动脉穿支（DIEP）皮瓣乳房重建术来改善乳房不对称的翻修手术数量仍然很高，这对患者和医疗保健系统都有影响。这些手术包括脂肪移植、对侧乳房对称化、疤痕修整、皮瓣重新定位和重塑。先前发表的 DIEP 皮瓣插入算法已被证明可有效选择针对患者的策略，以实现出色的美学效果。本研究调查了在接受 SSM 和即刻 DIEP 皮瓣乳房重建术的患者中，该插入算法是否可有效减少翻修手术，以实现一次性重建的目标。

方法

本回顾性病例对照研究纳入 60 例（A 组）未使用 DIEP 皮瓣标准化插入算法治疗的患者和 60 例（B 组）使用标准化插入算法治疗的患者，该算法考虑了要重建的乳房类型、腹部组织厚度、由于采集侧引起的旋转等变量。记录了人口统计学数据、手术数据、并发症和翻修手术次数。

结果

共进行了 120 例原发性手术和 106 例翻修手术。两组在年龄（p=0.32）、体重指数（p=0.77）、皮瓣重量（p=0.7）、手术时间（p=0.87）和早期并发症（p=0.78）方面无差异。当将孤立的乳头重建从翻修手术中排除时，A 组中有 26 例（43.3%）和 B 组中有 39 例（65.0%）成功进行了一次性重建，两组之间存在统计学差异（p=0.003）。