Abstract：
BACKGROUND: The deep inferior epigastric perforator (DIEP) free flap is the gold standard procedure for autologous breast reconstruction. Although breast-related complications have been well described, donor-site complications and contributing patient risk factors are poorly understood.
METHODS: We examined a multi-institutional, prospectively maintained database of patients undergoing DIEP free flap breast reconstruction between 2015 and 2020. We evaluated patient demographics, operative details, and abdominal donor-site complications. Logistic regression modeling was used to predict donor-site outcomes based on patient characteristics.
RESULTS: A total of 661 patients were identified who underwent DIEP free flap breast reconstruction across multiple institutions. Using logistic regression modeling, we found that body mass index (BMI) was an independent risk factor for umbilical complications (odds ratio [OR] 1.11, confidence interval [CI] 1.04-1.18, p = 0.001), seroma (OR 1.07, CI 1.01-1.13, p = 0.003), wound dehiscence (OR 1.10, CI 1.06-1.15, p = 0.001), and surgical site infection (OR 1.10, CI 1.05-1.15, p = 0.001) following DIEP free flap breast reconstruction. Further, immediate reconstruction decreases the risk of abdominal bulge formation (OR 0.22, CI 0.108-0.429, p = 0.001). Perforator selection was not associated with abdominal morbidity in our study population.
CONCLUSIONS: Higher BMI is associated with increased abdominal donor-site complications following DIEP free flap breast reconstruction. Efforts to lower preoperative BMI may help decrease donor-site complications.
METHODS: We examined a multi-institutional, prospectively maintained database of patients undergoing DIEP free flap breast reconstruction between 2015 and 2020. We evaluated patient demographics, operative details, and abdominal donor-site complications. Logistic regression modeling was used to predict donor-site outcomes based on patient characteristics.
RESULTS: A total of 661 patients were identified who underwent DIEP free flap breast reconstruction across multiple institutions. Using logistic regression modeling, we found that body mass index (BMI) was an independent risk factor for umbilical complications (odds ratio [OR] 1.11, confidence interval [CI] 1.04-1.18, p = 0.001), seroma (OR 1.07, CI 1.01-1.13, p = 0.003), wound dehiscence (OR 1.10, CI 1.06-1.15, p = 0.001), and surgical site infection (OR 1.10, CI 1.05-1.15, p = 0.001) following DIEP free flap breast reconstruction. Further, immediate reconstruction decreases the risk of abdominal bulge formation (OR 0.22, CI 0.108-0.429, p = 0.001). Perforator selection was not associated with abdominal morbidity in our study population.
CONCLUSIONS: Higher BMI is associated with increased abdominal donor-site complications following DIEP free flap breast reconstruction. Efforts to lower preoperative BMI may help decrease donor-site complications.
摘要：
背景：腹壁下深穿支（DIEP）游离皮瓣是自体乳房重建的金标准手术。尽管乳房相关的并发症已经得到了很好的描述，对供体部位并发症和患者危险因素了解甚少.
方法：我们研究了多机构，前瞻性维护2015年至2020年间接受DIEP游离皮瓣乳房再造患者的数据库.我们评估了病人的人口统计学,操作细节,和腹部供体部位并发症。使用Logistic回归模型根据患者特征预测供体部位结果。
结果：共有661例患者在多个机构接受了DIEP游离皮瓣乳房再造。使用逻辑回归建模，我们发现体重指数（BMI）是脐带并发症的独立危险因素（比值比[OR]1.11，置信区间[CI]1.04-1.18，p=0.001），血清肿（OR1.07，CI1.01-1.13，p=0.003），伤口裂开（OR1.10，CI1.06-1.15，p=0.001），DIEP游离皮瓣乳房重建后的手术部位感染（OR1.10，CI1.05-1.15，p=0.001）。Further,即刻重建可降低腹部隆起形成的风险(OR0.22,CI0.108-0.429,p=0.001)。在我们的研究人群中，穿孔器选择与腹部发病率无关。
结论：较高的BMI与DIEP游离皮瓣乳房重建后腹部供血部位并发症增加相关。降低术前BMI的努力可能有助于减少供体部位的并发症。
方法：我们研究了多机构，前瞻性维护2015年至2020年间接受DIEP游离皮瓣乳房再造患者的数据库.我们评估了病人的人口统计学,操作细节,和腹部供体部位并发症。使用Logistic回归模型根据患者特征预测供体部位结果。
结果：共有661例患者在多个机构接受了DIEP游离皮瓣乳房再造。使用逻辑回归建模，我们发现体重指数（BMI）是脐带并发症的独立危险因素（比值比[OR]1.11，置信区间[CI]1.04-1.18，p=0.001），血清肿（OR1.07，CI1.01-1.13，p=0.003），伤口裂开（OR1.10，CI1.06-1.15，p=0.001），DIEP游离皮瓣乳房重建后的手术部位感染（OR1.10，CI1.05-1.15，p=0.001）。Further,即刻重建可降低腹部隆起形成的风险(OR0.22,CI0.108-0.429,p=0.001)。在我们的研究人群中，穿孔器选择与腹部发病率无关。
结论：较高的BMI与DIEP游离皮瓣乳房重建后腹部供血部位并发症增加相关。降低术前BMI的努力可能有助于减少供体部位的并发症。
