Abstract：
Patients undergoing breast reconstruction with the deep inferior epigastric perforator (DIEP) flap are at risk of arterial and venous thrombosis, necessitating flap salvage surgery. However, this carries the risk of ischemia-reperfusion injury (IRI) and potential significant partial or complete flap loss. The objective of this study was to evaluate the potential benefit of corticosteroids in reducing IRI related complications in DIEP flaps that are returned to the operation theater for attempted salvage after venous or arterial failure. A double-blinded prospective randomized study was conducted between January 2012 and January 2023 on patients scheduled for secondary unilateral breast reconstruction using the DIEP flap technique. Patients were included if they developed post-operative venous or arterial flap thrombosis and experienced DIEP flap IRI following operative take-back and anastomosis revision. The treatment group (TG) received a 5-day course of corticosteroids, while the control group (CG) did not receive any specific treatment. Forty-six patients were enrolled in the study. In the CG, two cases of total flap loss and eight cases of partial flap necrosis were observed, while the TG had only 1 case of partial flap necrosis (p < 0.05). The complete resolution of clinical signs of IRI occurred within 13 ± 2.1 days for the TG and 21 ± 3.5 days for the CG (p = 0.00001). The TG had a significantly shorter hospital stay (11.13 ± 0.38 days) compared with the CG (15.47 ± 1.27 days; p < 0.0001). Targeted corticosteroid therapy following a salvage procedure for vascular thrombosis in DIEP flaps has shown promise as an effective treatment for subsequent IRI. This approach may be considered as a viable option for managing IRI in free flaps. However, further studies involving a larger number of patients are required to substantiate our hypothesis.
摘要：
使用深腹壁下穿支（DIEP）皮瓣进行乳房重建的患者存在动脉和静脉血栓形成的风险。需要皮瓣抢救手术。然而,这带来了缺血再灌注损伤(IRI)和潜在的显著部分或完全皮瓣丢失的风险.这项研究的目的是评估皮质类固醇在减少DIEP皮瓣中IRI相关并发症的潜在益处，这些皮瓣在静脉或动脉衰竭后返回手术室进行抢救。在2012年1月至2023年1月之间，对计划使用DIEP皮瓣技术进行二次单侧乳房重建的患者进行了一项双盲前瞻性随机研究。如果患者发生术后静脉或动脉皮瓣血栓形成，并在手术回缩和吻合翻修后经历DIEP皮瓣IRI，则将其包括在内。治疗组（TG）接受为期5天的糖皮质激素治疗，而对照组(CG)未接受任何特异性治疗。46名患者被纳入研究。在CG中,观察到2例皮瓣完全丢失，8例皮瓣部分坏死，而TG仅1例皮瓣部分坏死（p<0.05）。IRI临床体征的完全缓解发生在TG的13±2.1天内，CG的21±3.5天内（p=0.00001）。与CG（15.47±1.27天；p<0.0001）相比，TG的住院时间明显缩短（11.13±0.38天）。DIEP皮瓣中血管血栓形成的抢救程序后的靶向皮质类固醇治疗已显示出有望作为后续IRI的有效治疗方法。这种方法可以被认为是管理自由襟翼中的IRI的可行选择。然而,需要涉及更多患者的进一步研究来证实我们的假设.
