Smit Jan Maerten, Plat Victor D, van Est Marijn L Q, van der Velde Susanne, Daams Freek, Negenborn Vera L
Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
Department of Surgical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
JPRAS Open. 2024 Jul 31;42:10-21. doi: 10.1016/j.jpra.2024.07.010. eCollection 2024 Dec.
Breast cancer is the most common cancer in women, and breast reconstruction improves the patient's quality of life. Autologous breast reconstruction provides benefits of natural appearance, feel, and long-term results without implant-associated problems. However, thin patients are not always suitable for standard autologous reconstructions. In these patients, an omental flap could be a useful alternative. The aim of this review was to provide an overview of the literature regarding the clinical outcomes of omental flaps in breast reconstruction.
A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Medline and Embase databases up to November 1, 2023. Study outcomes were type of flap, tissue transfer, cosmetic outcomes, and short- and long-term complications.
Eleven studies covering 985 reconstructions in 969 patients were included. The omentum was mostly laparoscopically harvested (88.6%) and a pedicled reconstruction was mostly performed (91.2%). The most commonly reported short-term complications were wound infections at the donor site (5.8%), partial flap necrosis, and fat necrosis. In the long term, epigastric, umbilical and tunnel hernias, and epigastric bulging were observed. Satisfactory cosmetic results were reported by the patients (88.7%) and professionals (80.0%).
Breast reconstruction using an omental flap can be performed in unilateral reconstructions with acceptable donor-site morbidity if laparoscopically harvested. In general, satisfactory cosmetic outcomes were reported and it appears to be a suitable alternative for selected patients who prefer autologous, unilateral breast reconstruction. Further research is necessary to determine the ideal candidates for this reconstruction and the long-term effects of an omentectomy in young patients.
乳腺癌是女性最常见的癌症，乳房重建可改善患者的生活质量。自体乳房重建具有外观自然、触感良好和长期效果佳的优点，且无植入相关问题。然而，体型消瘦的患者并不总是适合标准的自体重建。对于这些患者，网膜瓣可能是一种有用的替代方法。本综述的目的是概述有关网膜瓣在乳房重建中临床结果的文献。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用Medline和Embase数据库进行系统评价，检索截至2023年11月1日的文献。研究结果包括瓣的类型、组织转移、美容效果以及短期和长期并发症。
纳入了11项研究，涉及969例患者的985例重建手术。网膜大多通过腹腔镜获取（88.6%），大多采用带蒂重建（91.2%）。最常报告的短期并发症是供区伤口感染（5.8%）、部分瓣坏死和脂肪坏死。从长期来看，观察到上腹部、脐部和隧道疝以及上腹部膨出。患者（88.7%）和专业人员（80.0%）均报告美容效果满意。
如果通过腹腔镜获取网膜，使用网膜瓣进行乳房重建可用于单侧重建，供区发病率可接受。总体而言，报告的美容效果令人满意，对于选择自体单侧乳房重建的特定患者，它似乎是一种合适的替代方法。有必要进一步研究以确定这种重建的理想候选者以及年轻患者行网膜切除的长期影响。
