Rezania Nikki, Harmon Kelly A, Frauchiger-Ankers Reilly, La-Anyane Okensama, Idrizi Keid, To Jocelyn, Ritz Ethan M, Kurlander David E, Shenaq Deana, Kokosis George
Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois.
Frank H. Netter School of Medicine, Quinnipiac University, North Haven, Connecticut.
J Reconstr Microsurg. 2025 Mar;41(3):237-247. doi: 10.1055/s-0044-1788564. Epub 2024 Jul 17.
This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.
A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria. Sixty-four studies were included in the analysis for bulge and 71 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman-Tukey double arcsine method.
The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (β = 0.0059, = 0.0117), prior abdominal surgery (β = 0.0008, = 0.046), and pregnancy history (β = -0.0015, = 00001) were significantly associated with hernia. Active smoking (β = 0.0032, = 00262) and pregnancy history (β = 0.0019, 0.0001) were significantly associated with bulge. Neither the perforator vessel laterality nor the number of perforator vessels harvested had any association with hernia or bulge. Prophylactic mesh placement was not associated with hernia or bulge.
Understanding the comorbidities associated with hernia or bulge following DIEP flap breast reconstruction, such as advanced age, prior abdominal surgery, pregnancy history, and active smoking status, allows surgeons to proactively identify and educate high-risk patients. Future studies may further explore whether prophylactic mesh placement offers patients any benefit.
本荟萃回归旨在研究接受腹壁下深动脉穿支（DIEP）皮瓣手术患者发生腹疝和腹壁膨出的危险因素，以及预防性放置补片对术后并发症的影响。
2022年7月，按照系统评价和荟萃分析的首选报告项目指南进行了系统检索。2000年至2022年发表的74项研究符合纳入标准。64项研究纳入腹壁膨出分析，71项研究纳入腹疝分析。对发生腹疝或腹壁膨出的患者比例进行荟萃回归，以评估患者危险因素及预防性放置补片的作用。比例采用弗里曼-图基双反正弦法进行转换。
发现DIEP皮瓣术后腹疝和腹壁膨出的平均发生率分别为0.18%和1.26%。年龄增加（β = 0.0059，P = 0.0117）、既往腹部手术史（β = 0.0008，P = 0.046）和妊娠史（β = -0.0015，P = 0.0001）与腹疝显著相关。主动吸烟（β = 0.0032，P = 0.0262）和妊娠史（β = 0.0019，P = 0.0001）与腹壁膨出显著相关。穿支血管的位置和获取的穿支血管数量与腹疝或腹壁膨出均无关联。预防性放置补片与腹疝或腹壁膨出无关。
了解DIEP皮瓣乳房重建术后与腹疝或腹壁膨出相关的合并症，如高龄、既往腹部手术史、妊娠史和主动吸烟状况，有助于外科医生主动识别并对高危患者进行教育。未来研究可进一步探讨预防性放置补片是否对患者有益。
