60 岁以上患者的微血管自体乳房再造评估。
Evaluation of Microvascular Autologous Breast Reconstruction in Patients Older Than 60 Years.
机构信息
From the Division of Plastic Surgery, Department of Surgery, University of California, San Francisco, San Francisco.
University of California, Irvine, School of Medicine, Irvine, CA.
出版信息
Ann Plast Surg. 2023 Jul 1;91(1):96-100. doi: 10.1097/SAP.0000000000003557. Epub 2023 May 9.
BACKGROUND
While free-flap breast reconstruction becomes more common, it is still approached with caution in older patients. Outcomes in the elderly population have not been well characterized, especially with regard to donor-site sequalae. This study compares microvascular autologous breast reconstruction outcomes in patients older and younger 60 years.
METHODS
A single-institution retrospective review was performed for microvascular autologous breast reconstruction from January 2004 through January 2021. Demographic, intraoperative, and postoperative variables, including breast flap and donor-site complications, were evaluated.
RESULTS
Five hundred forty-five breast free flaps were identified, of which 478 (87.8%) were performed on patients younger than 60 years (mean, 46.2 years) and 67 (12.2%) older than 60 years (mean, 64.8 years; P = 0.000). Hyperlipidemia was significantly higher in older patients (19.4% vs 9.6%, P = 0.016). Mean operative time was 46.3 minutes faster in the older cohort ( P = 0.030). There were no significant differences in free-flap loss, venous congestion, takeback, hematoma, seroma, wound healing, or infection. Interestingly, there were significantly more total breast flap complications (28.5% vs 16.4%, P = 0.038) and higher rates of fat necrosis (9.6% vs 1.5%, P = 0.026) in the younger cohort. Significantly more abdominal donor-site complications (43.3% vs 21.3%, P = 0.000) were seen in the older people, with increased wound breakdown ( P = 0.000) and any return to the operating room (20.9% vs 9.8%, P = 0.007). Older patients were also significantly more likely to require surgical correction of an abdominal bulge or hernia (10.4% vs 4%, P = 0.020). The mean follow-up was 1.8 years.
CONCLUSIONS
Our data showed no worsening of individual breast flap outcomes in the older people. However, there were significantly more abdominal complications including surgical correction of abdominal bulge and hernia. This may be related to the inherent qualities of tissue aging and should be taken into consideration for flap selection. These results support autologous breast reconstruction in patients older than 60 years, but patients should be counseled regarding potentially increased abdominal donor-site sequelae.
背景
随着游离皮瓣乳房再造术的应用越来越广泛，老年患者对此仍持谨慎态度。目前尚未充分描述老年患者的结局，尤其是供区并发症。本研究比较了年龄大于和小于 60 岁的患者行游离皮瓣乳房再造术的结果。
方法
对 2004 年 1 月至 2021 年 1 月期间行游离皮瓣乳房再造术的患者进行单中心回顾性研究。评估了患者的人口统计学、术中及术后变量，包括乳房皮瓣和供区并发症。
结果
共纳入 545 例游离皮瓣，其中 478 例（87.8%）患者年龄小于 60 岁（平均年龄 46.2 岁），67 例（12.2%）患者年龄大于 60 岁（平均年龄 64.8 岁；P=0.000）。老年患者高脂血症的发生率显著更高（19.4% vs 9.6%，P=0.016）。老年组的手术时间平均快 46.3 分钟（P=0.030）。游离皮瓣丢失、静脉淤滞、翻修、血肿、血清肿、伤口愈合或感染等并发症在两组间无显著差异。有趣的是，年轻组的总乳房皮瓣并发症发生率更高（28.5% vs 16.4%，P=0.038），且脂肪坏死的发生率更高（9.6% vs 1.5%，P=0.026）。老年患者的腹部供区并发症发生率更高（43.3% vs 21.3%，P=0.000），包括伤口裂开（P=0.000）和任何再次手术（20.9% vs 9.8%，P=0.007）。老年患者还更可能需要手术矫正腹部膨隆或疝（10.4% vs 4%，P=0.020）。平均随访时间为 1.8 年。
结论
我们的数据显示，老年患者的单个乳房皮瓣结局没有恶化。然而，腹部并发症显著更多，包括腹部膨隆和疝的手术矫正。这可能与组织老化的固有特性有关，在选择皮瓣时应予以考虑。这些结果支持 60 岁以上患者行游离皮瓣乳房再造术，但应告知患者可能增加的腹部供区并发症。
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