Alves André S, Tan Vincent, Scampa Matteo, Kalbermatten Daniel F, Oranges Carlo M
Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, Switzerland.
Cancers (Basel). 2022 Sep 1;14(17):4272. doi: 10.3390/cancers14174272.
The setting regarding the ideal timing for deep inferior epigastric perforator flap (DIEP) reconstruction remains unclear. Immediate breast reconstruction (IBR) is performed at the same time as mastectomy, while delayed breast reconstruction (DBR) is performed at any time after mastectomy except immediately. We compared both strategies to assess whether IBR or DBR should be performed to reduce postoperative adverse events.
A systematic review of PubMed, Embase, Medline, Cochrane, and Web of Science was conducted, aiming at articles comparing the recipient site outcomes of IBR versus DBR with DIEP. We used the Mantel-Haenszel method with a fixed effects model. Results were expressed as the OR with a 95% CI.
Two retrospective and two prospective studies were identified involving 5784 DIEPs (1744 immediate and 4040 delayed). We showed a significant difference in favor of IBR for wound healing issues (OR = 0.57, 95% CI 0.41, 0.77; = 0.0003). However, no significant differences for hematoma, infection, fat necrosis, partial flap loss, and total flap loss rate were seen.
Despite variability in the choice of the ideal time for breast reconstruction and outcomes reported among studies, immediate DIEP surgery appears to be a reliable setting with less delayed healing issues.
关于腹壁下深动脉穿支皮瓣（DIEP）重建的理想时机仍不明确。即刻乳房重建（IBR）与乳房切除术同时进行，而延迟乳房重建（DBR）在乳房切除术后除即刻外的任何时间进行。我们比较了这两种策略，以评估应进行IBR还是DBR来减少术后不良事件。
对PubMed、Embase、Medline、Cochrane和科学网进行系统评价，旨在寻找比较IBR与DBR采用DIEP时受区结局的文章。我们使用固定效应模型的Mantel-Haenszel方法。结果以95%置信区间的比值比（OR）表示。
确定了两项回顾性研究和两项前瞻性研究，涉及5784例DIEP皮瓣（1744例即刻和4040例延迟）。我们发现，在伤口愈合问题上，IBR具有显著优势（OR = 0.57，95% CI 0.41，0.77；P = 0.0003）。然而，在血肿、感染、脂肪坏死、部分皮瓣丢失和总皮瓣丢失率方面未发现显著差异。
尽管在乳房重建理想时间的选择以及研究报告的结局方面存在差异，但即刻DIEP手术似乎是一种可靠的方式，愈合延迟问题较少。
