Mersey Regional Plastic Surgery & Burn Unit, St Helens and Knowsley NHS Trust, Liverpool, UK.
Mersey Regional Plastic Surgery & Burn Unit, St Helens and Knowsley NHS Trust, Liverpool, UK.
J Plast Reconstr Aesthet Surg. 2022 Oct;75(10):3683-3689. doi: 10.1016/j.bjps.2022.06.017. Epub 2022 Jun 18.
Abdominal bulge in the absence of a hernia is a known complication following free abdominal flap breast reconstruction and can be associated with significant aesthetic and functional morbidity. This study aims to review the impact of permanent subrectus mesh placement on the incidence of post-DIEP bulge.
All patients over a 5-year period who underwent unilateral or bilateral DIEP breast reconstruction were included in the study. The cohort was divided into a "permanent mesh" (PM) and "no permanent mesh" (NPM) groups. Those in the PM group underwent placement of a permanent Bard™ Soft Polypropylene Mesh, and the NPM group comprised of patients who had a semi-permanent subrectus Vypro mesh or no mesh. The primary outcome of the study was the development of post-DIEP abdominal bulge or hernia. The secondary outcome was the incidence of other donor site complications such as infection. Post-operative follow-up was conducted for a minimum of 6 months.
The study included 276 patients, 134 of whom were in the NPM group and 142 in the PM group. Demographics including mean age, median BMI, incidence of pre-operative chemotherapy, radiotherapy, and prior abdominal surgery were comparable between the two groups. The incidence of post-operative abdominal bulge or hernia was lower in the PM group (PM= 0.7% vs. NPM=5.2%, p<0.05). There was no significant difference in the incidence of donor site infection between the two groups (PM=3.5 vs. NPM=2.2%, p=0.53).
Our study demonstrates that a low rate of abdominal morbidity can be achieved with the placement of a permanent subrectus mesh.
游离腹部皮瓣乳房重建后出现无疝的腹部膨出是一种已知的并发症，可导致明显的美学和功能发病率。本研究旨在回顾永久性腹直肌下网片放置对 DIEP 膨出后发病率的影响。
在 5 年期间，所有接受单侧或双侧 DIEP 乳房重建的患者均被纳入研究。该队列分为“永久性网片”（PM）和“无永久性网片”（NPM）组。PM 组行永久性 Bard Soft Polypropylene 网片放置，NPM 组为接受半永久性腹直肌下 Vypro 网片或无网片的患者。该研究的主要结局是发生 DIEP 后腹部膨出或疝。次要结局是评估其他供区并发症的发生率，如感染。术后随访时间至少为 6 个月。
该研究纳入了 276 例患者，其中 134 例为 NPM 组，142 例为 PM 组。两组的人口统计学特征包括平均年龄、中位 BMI、术前化疗、放疗和既往腹部手术的发生率均无显著差异。PM 组术后腹部膨出或疝的发生率较低（PM=0.7% vs. NPM=5.2%，p<0.05）。两组供区感染的发生率无显著差异（PM=3.5% vs. NPM=2.2%，p=0.53）。
我们的研究表明，放置永久性腹直肌下网片可降低腹部并发症的发生率。
