From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
Department of Plastic Surgery, Cleveland Clinic, Cleveland.
Plast Reconstr Surg. 2023 Oct 1;152(4):566e-577e. doi: 10.1097/PRS.0000000000010343. Epub 2023 Mar 3.
Deep inferior epigastric perforator (DIEP) flaps are the standard for autologous breast reconstruction. This study investigated risk factors for DIEP complications in a large, contemporary cohort to optimize surgical evaluation and planning.
This retrospective study included patients who underwent DIEP breast reconstruction between 2016 and 2020 at an academic institution. Demographics, treatment, and outcomes were evaluated in univariable and multivariable regression models for postoperative complications.
In total, 802 DIEP flaps were performed in 524 patients (mean age, 51.2 ± 9.6 years; mean body mass index, 29.3 ± 4.5). Most patients (87%) had breast cancer; 15% were BRCA -positive. There were 282 (53%) delayed and 242 (46%) immediate reconstructions and 278 (53%) bilateral and 246 (47%) unilateral reconstructions. Overall complications occurred in 81 patients (15.5%), including venous congestion (3.4%), breast hematoma (3.6%), infection (3.6%), partial flap loss (3.2%), total flap loss (2.3%), and arterial thrombosis (1.3%). Longer operative time was significantly associated with bilateral immediate reconstructions and higher body mass index. Prolonged operative time (OR, 1.16; P = 0.001) and immediate reconstruction (OR, 1.92; P = 0.013) were significant predictors of overall complications. Partial flap loss was associated with bilateral immediate reconstructions, higher body mass index, current smoking status, and longer operative time.
Prolonged operative time is a significant risk factor for overall complications and partial flap loss in DIEP breast reconstruction. For each additional hour of surgical time, the risk of developing overall complications increases by 16%. These findings suggest that reducing operative time through co-surgeon approaches, consistency in surgical teams, and counseling patients with more risk factors toward delayed reconstructions may mitigate complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
深部腹壁下动脉穿支（DIEP）皮瓣是自体乳房重建的标准方法。本研究旨在通过对大型当代队列进行研究，分析 DIEP 并发症的风险因素，从而优化手术评估和规划。
本回顾性研究纳入了 2016 年至 2020 年在某学术机构行 DIEP 乳房重建术的患者。对患者的人口统计学资料、治疗方法和结局进行单变量和多变量回归分析，以评估术后并发症的发生风险。
共纳入 524 例患者的 802 例 DIEP 皮瓣，患者平均年龄为 51.2 ± 9.6 岁，平均 BMI 为 29.3 ± 4.5。大多数患者（87%）患有乳腺癌，15%为 BRCA 阳性。其中 282 例（53%）为延迟重建，242 例（46%）为即刻重建；278 例（53%）为双侧重建，246 例（47%）为单侧重建。81 例（15.5%）患者发生并发症，包括静脉淤滞（3.4%）、乳房血肿（3.6%）、感染（3.6%）、部分皮瓣坏死（3.2%）、全皮瓣坏死（2.3%）和动脉血栓形成（1.3%）。双侧即刻重建和 BMI 较高与手术时间延长显著相关。较长的手术时间（OR，1.16；P=0.001）和即刻重建（OR，1.92；P=0.013）是总体并发症的显著预测因素。部分皮瓣坏死与双侧即刻重建、较高 BMI、当前吸烟状况和较长手术时间有关。
手术时间延长是 DIEP 乳房重建术发生总体并发症和部分皮瓣坏死的显著危险因素。手术时间每延长 1 小时，发生总体并发症的风险增加 16%。这些发现提示，通过共同手术医生、手术团队的一致性以及对具有更多危险因素的患者进行延迟重建的咨询，可以减少手术并发症。
临床问题/证据等级：风险，III 级。
