National Cancer Institute, Ministry of Health, Kyiv, Ukraine.
National Institute of Surgery and Transplantology, Kyiv, Ukraine.
J Med Life. 2023 Jan;16(1):121-128. doi: 10.25122/jml-2022-0227.
This study aimed to compare the results of free MS-TRAM and DIEP-flap based on the volume of the transplant and the unique characteristics of blood flow in the tissues. The study included 83 patients, 42 in the MS-TRAM-flap reconstruction group and 41 in the DIEP-flap breast reconstruction group. In the MS-TRAM-flap group, 35 patients received delayed reconstruction, and 7 received one-stage breast reconstruction, including one case of bilateral transplantation. In the DIEP-flap group, 5 patients received one-stage reconstruction, and 36 received delayed reconstruction. Complications associated with the flap tissue were observed in 7 (16.67%) in the MS-TRAM-flap group and 8 (19.51%) cases in the DIEP-flap group. The total level of fat necrosis in MS-TRAM-flap was 7.14% (p=0.033), and in DIEP-flap, it was 9.75% (p=0.039) (2 patients had a substantial amount of fat necrosis, while 2 patients had a modest amount of focal fat necrosis). The number and diameter of perforators (including veins), as well as the transplant volume, are the primary determinants of whether to use a DIEP- or MS-TRAM-flap. DIEP-flap is preferred if there are 1-2 large artery perforators (≥1 mm) and tissue volume of 700-800 grams, while MS-TRAM-flap is used when the tissue volume is significant (>2/3 of standard TRAM-flap).
本研究旨在比较游离 MS-TRAM 和 DIEP 皮瓣的结果，基于移植体积和组织内独特的血流特征。研究纳入 83 例患者，42 例接受 MS-TRAM 皮瓣重建，41 例接受 DIEP 皮瓣乳房重建。MS-TRAM 皮瓣组中，35 例接受延迟重建，7 例接受一期乳房重建，包括 1 例双侧移植。DIEP 皮瓣组中，5 例接受一期重建，36 例接受延迟重建。MS-TRAM 皮瓣组中有 7 例（16.67%）和 DIEP 皮瓣组中有 8 例（19.51%）发生与皮瓣组织相关的并发症。MS-TRAM 皮瓣的总脂肪坏死水平为 7.14%（p=0.033），DIEP 皮瓣为 9.75%（p=0.039）（2 例存在大量脂肪坏死，2 例存在少量局灶性脂肪坏死）。穿支（包括静脉）的数量和直径以及移植体积是决定使用 DIEP 或 MS-TRAM 皮瓣的主要因素。如果有 1-2 个大口径动脉穿支（≥1mm）和 700-800 克组织体积，建议选择 DIEP 皮瓣，而当组织体积较大（>标准 TRAM 皮瓣的 2/3）时，则使用 MS-TRAM 皮瓣。
