Bonafastia Sanderley J, Steenbeek Lennart M, Ulrich Dietmar J O, Hummelink Stefan
Radboud University Medical Centre Nijmegen, Sanderley.
Radboud University Medical Centre Nijmegen, Lennart.
JPRAS Open. 2024 Oct 19;43:169-179. doi: 10.1016/j.jpra.2024.10.010. eCollection 2025 Mar.
The purpose of this study was to evaluate the present-day practices in the preparation, peri-, and postoperative care for patients undergoing autologous free flap breast reconstructions (ABR) worldwide, with the aim of enhancing informed decision-making for plastic surgeons during the planning stages of ABR.
A global survey was conducted among 280 plastic surgeons and 39 plastic and reconstructive surgery societies worldwide, enquiring about flap and donor site selection, surgical actions, perforator imaging, and perioperative care during ABR.
Eighty-two responses were received, among which 71% (n=58) were completed questionnaires. The preferred flap of choice was the deep inferior epigastric perforator flap (85%, n=51), with the internal mammary artery as the most commonly used recipient vessel. Preoperative imaging for ABR was typically performed using computed tomography angiography (75%, n=44) and often combined with a handheld Doppler. Handheld Doppler was the most frequently used modality to localize perforator vessels during surgery (33%, n=19), with the majority using either one (47%, n=24) or two (51%, n=26) perforators intraoperatively. These preferences were consistent across all clinic types.Postoperatively, flap monitoring was primarily performed by the nursing staff, initially every hour on the first day and at reduced frequencies on subsequent days.The most commonly used modality for monitoring flap viability was the handheld Doppler. The average length of hospital stay was 5 days.
This study provides valuable insights into the current preparations and peri- and postoperative care in ABR procedures worldwide, aiding in the development of standardized practices and potentially improving patient outcomes.
本研究的目的是评估全球范围内接受自体游离皮瓣乳房重建术（ABR）患者的术前准备、围手术期及术后护理的当前实践情况，旨在在ABR规划阶段增强整形外科医生的知情决策能力。
对全球280名整形外科医生和39个整形与重建外科学会进行了一项全球调查，询问有关ABR期间皮瓣和供区选择、手术操作、穿支成像及围手术期护理的问题。
共收到82份回复，其中71%（n = 58）为完整问卷。首选皮瓣是腹壁下深穿支皮瓣（85%，n = 51），最常用的受区血管是胸廓内动脉。ABR的术前成像通常使用计算机断层血管造影（75%，n = 44），且常与手持多普勒联合使用。手持多普勒是手术期间定位穿支血管最常用的方式（33%，n = 19），大多数人术中使用一根（47%，n = 24）或两根（51%，n = 26）穿支。所有诊所类型的这些偏好均一致。术后，皮瓣监测主要由护理人员进行，最初在第一天每小时进行一次，随后几天频率降低。监测皮瓣存活能力最常用的方式是手持多普勒。平均住院时间为5天。
本研究为全球ABR手术的当前准备及围手术期和术后护理提供了有价值的见解，有助于制定标准化实践并可能改善患者预后。
