Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy; Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy.
J Plast Reconstr Aesthet Surg. 2024 May;92:61-70. doi: 10.1016/j.bjps.2024.02.053. Epub 2024 Feb 29.
Patients undergoing breast reconstruction with the deep inferior epigastric perforator (DIEP) flap are at risk of arterial and venous thrombosis, necessitating flap salvage surgery. However, this carries the risk of ischemia-reperfusion injury (IRI) and potential significant partial or complete flap loss. The objective of this study was to evaluate the potential benefit of corticosteroids in reducing IRI related complications in DIEP flaps that are returned to the operation theater for attempted salvage after venous or arterial failure. A double-blinded prospective randomized study was conducted between January 2012 and January 2023 on patients scheduled for secondary unilateral breast reconstruction using the DIEP flap technique. Patients were included if they developed post-operative venous or arterial flap thrombosis and experienced DIEP flap IRI following operative take-back and anastomosis revision. The treatment group (TG) received a 5-day course of corticosteroids, while the control group (CG) did not receive any specific treatment. Forty-six patients were enrolled in the study. In the CG, two cases of total flap loss and eight cases of partial flap necrosis were observed, while the TG had only 1 case of partial flap necrosis (p < 0.05). The complete resolution of clinical signs of IRI occurred within 13 ± 2.1 days for the TG and 21 ± 3.5 days for the CG (p = 0.00001). The TG had a significantly shorter hospital stay (11.13 ± 0.38 days) compared with the CG (15.47 ± 1.27 days; p < 0.0001). Targeted corticosteroid therapy following a salvage procedure for vascular thrombosis in DIEP flaps has shown promise as an effective treatment for subsequent IRI. This approach may be considered as a viable option for managing IRI in free flaps. However, further studies involving a larger number of patients are required to substantiate our hypothesis.
接受腹壁下动脉穿支皮瓣（DIEP）乳房再造的患者存在动脉和静脉血栓形成的风险，需要进行皮瓣挽救手术。然而，这会带来缺血再灌注损伤（IRI）的风险，以及潜在的显著部分或完全皮瓣丧失。本研究的目的是评估皮质类固醇在减少因静脉或动脉失败而返回手术室尝试挽救的 DIEP 皮瓣中与 IRI 相关的并发症的潜在益处。在 2012 年 1 月至 2023 年 1 月期间，对计划接受 DIEP 皮瓣技术进行二次单侧乳房再造的患者进行了一项双盲前瞻性随机研究。如果患者在术后出现静脉或动脉皮瓣血栓形成，并在皮瓣取回和吻合口修复后经历 DIEP 皮瓣 IRI，则纳入该研究。治疗组（TG）接受 5 天的皮质类固醇治疗，而对照组（CG）则未接受任何特定治疗。该研究共纳入 46 例患者。在 CG 中，观察到 2 例完全皮瓣坏死和 8 例部分皮瓣坏死，而 TG 中仅 1 例出现部分皮瓣坏死（p<0.05）。TG 的 IRI 临床体征完全缓解时间为 13±2.1 天，CG 为 21±3.5 天（p=0.00001）。TG 的住院时间明显短于 CG（11.13±0.38 天对 15.47±1.27 天；p<0.0001）。在 DIEP 皮瓣血管血栓形成的挽救手术后进行靶向皮质类固醇治疗，已显示出作为随后 IRI 的有效治疗方法的潜力。这种方法可以被认为是管理游离皮瓣 IRI 的一种可行选择。然而，需要进一步涉及更多患者的研究来证实我们的假设。
