Department of General and Plastic Surgery, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
Department of Plastic Surgery, Breast Surgery, and Burns, Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
J Plast Reconstr Aesthet Surg. 2023 Sep;84:266-272. doi: 10.1016/j.bjps.2023.05.022. Epub 2023 May 19.
The indications for microsurgical breast reconstruction remain debated, particularly concerning the safety of deep inferior epigastric perforator (DIEP) flaps in elderly women. Free tissue transfer still carries a risk of perioperative morbidity and mortality in elderly patients. We conducted this comparative study to clarify this issue.
This retrospective cohort study included all unilateral DIEP breast reconstructions performed at a single institution. Patients were divided into two groups based on age: an elderly (60 years or older) and a non-elderly cohort (younger than 60 years). Demographic and comorbidity data were secondary predictor variables. The primary outcomes were complete flap loss, partial flap loss, and the need for flap re-exploration. The secondary outcomes included surgical site occurrences, such as wound healing-related complications, seroma, and others.
We included 214 flaps, 177 in the non-elderly and 37 in the elderly cohort. Elderly women had slightly higher comorbidity rates than those of non-elderly women, although these differences were not statistically significant. BMI was significantly lower in elderly women than in non-elderly women. The incidence of total or partial flap loss did not differ significantly between the two cohorts (2.7% vs 1.1%, p = 0.459% and 0.0% vs 5.1%, p = 0.161), nor did the flap re-exploration (8.1% vs 10.1%, p = 0.937). Similarly, postoperative complication rates did not differ significantly between the two groups (45.9% vs 61.8%, p = 0.074). On logistic regression, being elderly was not a risk factor for complete flap loss, nor for any complications. The overall success rate for the non-elderly cohort was 98.7%, whereas that for the elderly cohort was 97.3%.
Microsurgical breast reconstruction using DIEP is safe in elderly patients, as it achieves outcomes and complications rates comparable to those observed in a younger population. Patients should not be denied DIEP flaps because of their age alone.
显微乳房重建的适应证仍存在争议，尤其是深部腹壁下动脉穿支（DIEP）皮瓣在老年女性中的安全性。游离组织移植在老年患者中仍有围手术期发病率和死亡率的风险。我们进行了这项比较研究来阐明这个问题。
这是一项回顾性队列研究，纳入了在一家机构进行的所有单侧 DIEP 乳房重建。患者根据年龄分为两组：老年组（60 岁及以上）和非老年组（60 岁以下）。人口统计学和合并症数据为次要预测变量。主要结局是完全皮瓣失活、部分皮瓣失活和需要皮瓣再次探查。次要结局包括手术部位发生的情况，如伤口愈合相关并发症、血清肿等。
我们纳入了 214 个皮瓣，其中 177 个在非老年组，37 个在老年组。老年女性的合并症发生率略高于非老年女性，但差异无统计学意义。老年女性的 BMI 明显低于非老年女性。两组之间总或部分皮瓣失活的发生率无显著差异（2.7%比 1.1%，p=0.459%和 0.0%比 5.1%，p=0.161%），皮瓣再次探查的发生率也无显著差异（8.1%比 10.1%，p=0.937%）。同样，两组术后并发症发生率也无显著差异（45.9%比 61.8%，p=0.074%）。在逻辑回归中，年龄大并不是完全皮瓣失活的危险因素，也不是任何并发症的危险因素。非老年组的总体成功率为 98.7%，老年组为 97.3%。
DIEP 用于老年患者的显微乳房重建是安全的，其结果和并发症发生率与年轻人群相当。不应仅因年龄而拒绝为老年患者提供 DIEP 皮瓣。
