PDF(Pubmed)
Abstract：
The purpose of this study is to compare outcomes in patients undergoing buried and non-buried free flaps for breast reconstruction, in addition to evaluating the safety and reliability of venous flow couplers. A retrospective review was performed of all patients undergoing free flap breast reconstruction between 2013 and 2023. The primary outcomes were free flap failure, complications and the number of procedures required to complete the reconstructive journey. A total of 322 flaps were performed in 254 consecutive patients, with 47.5% (n = 153) being buried and 52.0% (n = 169) being non-buried reconstructions. The most common flap of choice being deep inferior epigastric artery perforator flaps (81.9%) followed by profunda artery perforator flaps (14.3%). There was no significant difference between the two groups in complications, including flap failure (buried 2.0% vs. non-buried 1.8% p = 0.902). There was a significant reduction in the number of procedures required to complete the reconstructive journey, with 52.2% (n = 59) of patients undergoing single-stage breast reconstruction in the buried group compared with only 25.5% (n = 36) in the non-buried group (p < 0.001). Two (0.6%) patients experienced a false negative in which the signal of the flow coupler was lost but the flap was perfused during re-exploration. No flap losses occurred without being identified in advance by a loss of audible venous flow signal. Buried free flap breast reconstruction is safe and requires fewer operations to complete patients\' reconstructive journey. Flow couplers are a safe and effective method of monitoring buried free flaps in breast reconstruction.
摘要：
这项研究的目的是比较接受掩埋和非掩埋游离皮瓣进行乳房重建的患者的结果，除了评估静脉流量耦合器的安全性和可靠性。回顾性分析了2013年至2023年接受游离皮瓣乳房重建的所有患者。主要结果是游离皮瓣失败，并发症和完成重建旅程所需的程序数量。在254例连续患者中共进行了322次皮瓣，其中47.5％（n=153）被掩埋，52.0％（n=169）被非掩埋重建。最常见的选择皮瓣是深腹下动脉穿支皮瓣（81.9％），其次是深动脉穿支皮瓣（14.3％）。两组在并发症方面无显著差异,包括襟翼故障(埋藏2.0%与非掩埋1.8%p=0.902)。完成重建旅程所需的程序数量大幅减少，掩埋组52.2%(n=59)的患者接受单阶段乳房再造，而非掩埋组只有25.5%(n=36)(p<0.001)。两名（0.6％）患者出现假阴性，其中流量耦合器的信号丢失，但在重新探查过程中灌注了皮瓣。在没有通过听觉静脉流量信号的丢失而事先确定的情况下，没有发生皮瓣丢失。掩埋游离皮瓣乳房重建是安全的，需要较少的手术来完成患者的重建旅程。流动耦合器是乳房重建中监测掩埋游离皮瓣的安全有效方法。
