Chowdhury Rafsan A, Kapila Ayush K, Mohanna Pari-Naz, See Marlene, Ho-Asjoe Mark, Rose Victoria, Roblin Paul, Mughal Maleeha
Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Plastic Surgery Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Plast Reconstr Aesthet Surg. 2025 Mar;102:489-497. doi: 10.1016/j.bjps.2024.01.031. Epub 2024 Feb 1.
Autologous breast reconstruction patients require thorough assessment, with the profunda femoris artery perforator (PAP) flap having become an important autologous reconstruction option alongside the deep inferior epigastric perforator (DIEP) flap. Breast reconstruction impacts patients psychologically, physically and mentally. The BREAST-Q aids in the assessment of patient-reported outcome measures (PROMs). We aim to critically compare postoperative clinical outcomes, aesthetic results, morbidity and patient satisfaction between patients undergoing DIEP and PAP flap reconstructions using clinical follow-up and PROMs.
A non-blinded two-armed prospective cohort study was performed. Patients undergoing PAP or DIEP flap reconstructions between January 2021 and February 2022 were included and followed up for at least one-year postoperatively. Demographic and per-operative data were acquired. BREAST-Q data were collected preoperatively and at 2-week, 3-month and 1-year intervals postoperatively.
157 patients had autologous breast reconstruction (207 flaps), with 129 (82.1%) DIEP patients and 21 (13.3%) PAP patients. 37 (28.6%) patients underwent bilateral DIEP reconstructions, and 1 (5%) PAP case was bilateral. The remaining PAP cases used stacked flaps for unilateral breast reconstruction. Mean ischaemia time for PAP was 55.29 (±15.59 minutes) compared to 69.52 (±21.74 minutes) for DIEP (p = 0.014). Donor site wound dehiscence was significantly higher with PAP reconstructions (p = 0.014).
At one-year follow-up, no significant differences in PROMs across all domains between DIEP and PAP flap reconstructions were noted. This reflects that PAP flap reconstructions, despite having a more challenging donor site and higher donor site complications, provide an excellent reconstructive option with similar patient-reported outcomes when compared to the gold-standard DIEP flap reconstruction.
自体乳房重建患者需要进行全面评估，股深动脉穿支（PAP）皮瓣已成为与腹壁下深动脉穿支（DIEP）皮瓣并列的重要自体重建选择。乳房重建会对患者的心理、身体和精神产生影响。BREAST-Q有助于评估患者报告的结局指标（PROMs）。我们旨在通过临床随访和PROMs，对接受DIEP和PAP皮瓣重建的患者的术后临床结局、美学效果、发病率和患者满意度进行严格比较。
进行了一项非盲双臂前瞻性队列研究。纳入2021年1月至2022年2月期间接受PAP或DIEP皮瓣重建的患者，并在术后至少随访一年。收集人口统计学和术中数据。术前以及术后2周、3个月和1年间隔收集BREAST-Q数据。
157例患者进行了自体乳房重建（207块皮瓣），其中129例（82.1%）为DIEP患者，21例（13.3%）为PAP患者。37例（28.6%）患者接受了双侧DIEP重建，1例（5%）PAP病例为双侧。其余PAP病例采用堆叠皮瓣进行单侧乳房重建。PAP的平均缺血时间为55.29（±15.59分钟），而DIEP为69.52（±21.74分钟）（p = 0.014）。PAP重建的供区伤口裂开明显更高（p = 0.014）。
在一年的随访中，DIEP和PAP皮瓣重建在所有领域的PROMs方面均未发现显著差异。这表明，PAP皮瓣重建尽管供区更具挑战性且供区并发症更高，但与金标准的DIEP皮瓣重建相比，在患者报告的结局方面提供了相似的良好重建选择。
