Miller Rebecca L R, Nguyen Christopher M, Peters Blair R, Sigurdson Leif, Hayakawa Thomas E J, Spiwak Rae, Dalke Kimberly, Buchel Edward W
From the Section of Plastic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Plast Reconstr Surg Glob Open. 2024 Sep 12;12(9):e6152. doi: 10.1097/GOX.0000000000006152. eCollection 2024 Sep.
The deep inferior epigastric perforator (DIEP) flap is the standard of care in autologous breast reconstruction. The superficial inferior epigastric artery perforator flap (SIEA) is an alternative reconstructive option, with the compromise of less donor-site morbidity but variable perfusion to subscarpal fat zones. Fat necrosis is a known complication from marginal perfusion variability. Volumetric analysis of fat necrosis has not been performed between the two reconstructive options, nor has the amount of flap necrosis following radiation. Our objective was to compare rates and volume of fat necrosis between single-perforator DIEP and SIEA flap techniques.
A single-center, blinded, prospective cohort study of patients randomized between SIEA and DIEP breast reconstruction was conducted over 2 years (June 2011-July 2013). Inclusion criteria were women undergoing immediate reconstruction following mastectomy. Randomization protocols were strictly followed. Fat necrosis volumetric analysis was determined by an ultrasound-trained attending surgeon at 12 months postoperatively. Patient demographics and adjuvant/neoadjuvant cancer treatment were analyzed. Statistical analyses included Mann-Whitney U tests, chi square, and/or Fisher exact tests. values of 0.05 or less were considered significant.
Fat necrosis was detected in 11 of 46 flaps (23.9%), with a median area of 17.9 cm. There was no significant difference in prevalence of fat necrosis between the two flap types ( = 0.19). Postoperative radiation did not increase the prevalence ( = 0.30) or extent ( = 0.92) of fat necrosis.
Single-perforator DIEP and SIEA flaps have comparable rates of fat necrosis. Postoperative radiation did not result in increased prevalence or extent of fat necrosis.
腹壁下深动脉穿支（DIEP）皮瓣是自体乳房重建的标准术式。腹壁下浅动脉穿支皮瓣（SIEA）是一种替代重建选择，其优点是供区并发症较少，但对皮下脂肪区域的灌注情况不一。脂肪坏死是已知的因边缘灌注差异导致的并发症。尚未对这两种重建方式之间的脂肪坏死进行体积分析，也未对放疗后皮瓣坏死的量进行分析。我们的目的是比较单穿支DIEP和SIEA皮瓣技术中脂肪坏死的发生率和体积。
在2年时间内（2011年6月至2013年7月），对随机接受SIEA和DIEP乳房重建的患者进行了一项单中心、盲法、前瞻性队列研究。纳入标准为乳房切除术后立即进行重建的女性。严格遵循随机分组方案。术后12个月由一名接受过超声培训的主治医生进行脂肪坏死体积分析。分析患者的人口统计学资料以及辅助/新辅助癌症治疗情况。统计分析包括曼-惠特尼U检验、卡方检验和/或费舍尔精确检验。P值小于或等于0.05被认为具有统计学意义。
46例皮瓣中有11例（23.9%）检测到脂肪坏死，中位面积为17.9平方厘米。两种皮瓣类型之间脂肪坏死的发生率无显著差异（P = 0.19）。术后放疗并未增加脂肪坏死的发生率（P = 0.30）或范围（P = 0.92）。
单穿支DIEP和SIEA皮瓣的脂肪坏死发生率相当。术后放疗并未导致脂肪坏死的发生率或范围增加。
