Huang Hao, Jung Wooram F, Otterburn David M
From the NewYork-Presbyterian/Weill Cornell Medical Center.
Plast Reconstr Surg. 2023 Mar 1;151(3):477e-484e. doi: 10.1097/PRS.0000000000009933. Epub 2022 Nov 29.
Despite the umbilicus being an essential aesthetic unit, current literature on umbilical outcomes following abdominally based breast reconstruction is limited. In this study, the authors aim to elucidate the incidence and predictors of umbilical complications following deep inferior epigastric perforator (DIEP) flaps, with a particular emphasis on past abdominal surgery by type and measures that can be obtained easily from preoperative imaging.
An institutional review board-approved retrospective review of 258 patients who underwent DIEP flap reconstruction from 2011 through 2020 was performed. Patient demographics, preoperative laboratory studies, and intraoperative factors were appraised. Preoperative computed tomographic angiography or magnetic resonance angiography was used to measure umbilical stalk height (SH), abdominal wall thickness (AWT), and total fascial diastasis. Patients with and without perfusion-related umbilical complications were compared.
Forty patients (15.5%) developed umbilical complications, including 20 patients with epidermolysis or scab, 12 with dehiscence, and 14 with partial necrosis. Patients with complications had a significantly higher rate of hypertension, previous abdominal midline incision, more lateral perforators per flap, longer umbilical stalk, and larger SH/AWT ratio ( P < 0.05). Logistic regression revealed that SH ( P = 0.006) and SH/AWT ratio ( P < 0.001) were the only significant predictors, with the latter having a greater area under the receiver operating characteristic curve (area under the curve, 0.79; P < 0.001).
Radiographic measurements of umbilical SH and SH/AWT ratio reliably predict the occurrence of umbilical complications, with the ratio having a more robust predictive ability. The authors propose the use of routine preoperative imaging to identify high-risk patients who may benefit from prophylactic measures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
尽管脐部是一个重要的美学单元，但目前关于腹部乳房重建术后脐部结局的文献有限。在本研究中，作者旨在阐明腹壁下深穿支（DIEP）皮瓣术后脐部并发症的发生率及预测因素，特别关注既往腹部手术的类型以及可从术前影像中轻松获得的指标。
对2011年至2020年期间接受DIEP皮瓣重建的258例患者进行了机构审查委员会批准的回顾性研究。评估了患者的人口统计学资料、术前实验室检查结果及术中因素。术前计算机断层血管造影或磁共振血管造影用于测量脐蒂高度（SH）、腹壁厚度（AWT）和总筋膜分离程度。比较了发生和未发生与灌注相关脐部并发症的患者。
40例患者（15.5%）发生了脐部并发症，包括20例表皮松解或结痂、12例裂开和14例部分坏死。发生并发症的患者高血压发生率显著更高，既往有腹部中线切口，每侧皮瓣外侧穿支更多，脐蒂更长，且SH/AWT比值更大（P < 0.05）。逻辑回归显示，SH（P = 0.006）和SH/AWT比值（P < 0.001）是仅有的显著预测因素，后者在受试者工作特征曲线下面积更大（曲线下面积为0.79；P < 0.
