Thakur Ishaan, Shepherd Henry, Soliman Bish
Westmead Hospital Plastic Surgery Department, Cnr Hawkesbury Road and Darcy Rd, Westmead, NSW, 2145.
JPRAS Open. 2024 Jul 5;41:336-346. doi: 10.1016/j.jpra.2024.06.014. eCollection 2024 Sep.
The deep inferior epigastric artery perforator (DIEP) free flap is the gold-standard for breast reconstruction but is technically demanding, resource intensive and time-consuming, making it a daunting task for the junior surgeon.
To report the lessons learnt from the experience of a single surgeon performing their first 150 DIEP reconstructions as a guide for junior surgeons.
Data regarding patient demographics and surgical outcomes from April 2021 to October 2022 were collected retrospectively from medical records. Surgical outcomes were analysed using Microsoft Excel.
Over 17 months, 150 flaps were completed in 97 patients by the senior author (BS). Operative duration was negatively correlated with case number for unilateral DIEPs (r = -0.73, p < 0.05) and for bilateral DIEPs (r = -0.67, p = 0.14). Raise time and ischaemic time were also negatively correlated with case number (r = -0.82, p < 0.05 and r = -0.79, p < 0.05, respectively). There were 10 complications and no flap losses.
The data demonstrate an expected improvement in surgical efficiency with increased experience. We describe the key factors contributing to efficiency in our series, such as preoperative CT angiography, surgical markings prior to the day of surgery, a two-team approach with three diathermy sets, flap raise using monopolar diathermy, preference towards choosing a single dominant perforator and early commitment to perforator choice. This case series acts as a guide for the junior plastic surgeon in achieving safe, aesthetic and efficient results when completing free DIEP flap breast reconstructions.
腹壁下动脉穿支（DIEP）游离皮瓣是乳房重建的金标准，但技术要求高、资源消耗大且耗时，这对初级外科医生来说是一项艰巨的任务。
报告一名外科医生首次进行150例DIEP重建手术的经验教训，为初级外科医生提供指导。
回顾性收集2021年4月至2022年10月患者人口统计学数据和手术结果，从病历中获取相关信息。使用微软Excel分析手术结果。
在17个月内，资深作者（BS）为97例患者完成了150例皮瓣移植。单侧DIEP手术时间与病例数呈负相关（r = -0.73，p < 0.05），双侧DIEP手术时间与病例数也呈负相关（r = -0.67，p = 0.14）。掀起时间和缺血时间也与病例数呈负相关（分别为r = -0.82，p < 0.05和r = -0.79，p < 0.05）。发生了10例并发症，无皮瓣丢失。
数据表明，随着经验增加，手术效率会有预期的提高。我们描述了本系列中提高效率的关键因素，如术前CT血管造影、手术当天前的手术标记、使用三套双极电凝器的双团队方法、使用单极电凝器掀起皮瓣、倾向选择单一优势穿支以及尽早确定穿支选择。本病例系列为初级整形外科医生在完成游离DIEP皮瓣乳房重建时实现安全、美观和高效的结果提供了指导。
