Division of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
Department of Surgery, Division of Plastic Surgery, Louisiana State University School of Medicine, New Orleans, Louisiana, USA.
Microsurgery. 2024 Oct;44(7):e31220. doi: 10.1002/micr.31220.
With the rising popularity of the deep inferior epigastric perforator (DIEP) flap in breast reconstruction, use of the superficial inferior epigastric vein (SIEV) to augment venous outflow has been proposed as a strategy to prevent venous congestion, a complication positively associated with flap volume. This study evaluated the impact of routine SIEV venous augmentation on the risk of vascular complications or operative fat necrosis in the context of flap size and operating time.
A retrospective cohort study compared complication rates of patients with SIEV-augmented DIEP flaps to controls over a 3-year period. Outcomes assessed included vascular complications, defined as venous congestion or compromise requiring take-back, partial flap necrosis, total flap loss, as well as operative fat necrosis. Relative risk was modeled by Cox proportional hazard regression analysis. Sensitivity analysis was performed to assess for an interaction effect by flap mass.
The study sample included 197 patients with 316 flaps. The mean mass of the SIEV-augmented flaps was significantly greater than in the control group (832.9 vs. 653.9 g; p = 0.0007). After adjustment for flap characteristics, patient demographic factors, and comorbidities, pooled risk of vascular complication and operative fat necrosis was found to be significantly lower in the SIEV-augmented group compared to controls (hazard ratio = 0.33, 95% CI [0.11-1.00]; p = 0.0489). Sensitivity analysis demonstrated no effect interaction by flap weight (p = 0.5139).
Routine venous outflow augmentation via anastomosis of SIEV to the internal mammary vein perforator at the second intercostal space significantly reduced the risk of vascular complications and operative fat necrosis, regardless of flap weight. No significant increase in operative time was observed among cases in which augmentation was performed.
随着深部腹壁下血管穿支皮瓣（DIEP）在乳房重建中的应用日益普及，有人提出利用浅表腹壁下静脉（SIEV）来增加静脉回流，以预防静脉淤血，这是一种与皮瓣体积呈正相关的并发症。本研究评估了在皮瓣大小和手术时间的背景下，常规 SIEV 静脉增粗对血管并发症或手术性脂肪坏死风险的影响。
回顾性队列研究比较了 3 年内 SIEV 增粗 DIEP 皮瓣患者与对照组的并发症发生率。评估的结果包括血管并发症，定义为静脉淤血或需要回取的血管阻塞、部分皮瓣坏死、全皮瓣坏死以及手术性脂肪坏死。采用 Cox 比例风险回归分析模型来评估相对风险。进行敏感性分析，以评估皮瓣质量的交互作用效应。
研究样本包括 197 例患者的 316 个皮瓣。SIEV 增粗皮瓣的平均质量明显大于对照组（832.9 克 vs. 653.9 克；p=0.0007）。在调整皮瓣特征、患者人口统计学因素和合并症后，与对照组相比，SIEV 增粗组的血管并发症和手术性脂肪坏死的 pooled 风险显著降低（风险比=0.33，95%CI [0.11-1.00]；p=0.0489）。敏感性分析显示，皮瓣重量无交互作用效应（p=0.5139）。
在第二肋间隙通过 SIEV 与肋间内动脉穿支吻合进行常规静脉流出增粗，可显著降低血管并发症和手术性脂肪坏死的风险，与皮瓣重量无关。在进行增粗的情况下，并未观察到手术时间的显著增加。
