PDF(Pubmed)
Abstract：
Background: The aim of this study was to examine the potential benefit that may be achieved through the introduction of technical innovations and the incorporation of mesh for fascial donor site closure in uni- and bilateral autologous breast reconstruction with abdominal tissue. Methods: A retrospective single-center review of all breast reconstructions with a DIEP or MS-TRAM flap between January 2004 and December 2019 was performed. Donor and recipient site complications and operation times were evaluated before and after the implementation of coupler anastomoses, preoperative computed tomography angiography (CTA), indocyanine green (ICG) angiography, and the inclusion of mesh in donor site repair. Results: A total of 396 patients were included, accounting for 447 flaps. Operation time was significantly shorter in unilateral reconstructions after the implementation of CTA (p < 0.0001). ICG angiography significantly reduced the rates of partial flap loss (p = 0.02) and wound healing disorders (p = 0.02). For unilateral reconstructions, abdominal bulging or hernia was observed more often in MS1-TRAM flaps without synthetic mesh repair (p = 0.001), whereas conservatively treated seroma developed more frequently after mesh implantation (p = 0.03). Conclusions: Recent technological advancements developed over the past few decades have made a substantial impact on decreasing surgical duration and enhancing procedure safety.
摘要：
背景：这项研究的目的是研究通过引入技术创新和在腹部组织的单侧和双侧自体乳房重建中结合网状物用于筋膜供体部位闭合的潜在益处。方法：对2004年1月至2019年12月期间所有使用DIEP或MS-TRAM皮瓣进行乳房重建的回顾性单中心回顾。在实施耦合器吻合术前后评估供体和受体部位的并发症和手术时间，术前计算机断层扫描血管造影（CTA），吲哚菁绿(ICG)血管造影术,以及在供体部位修复中加入网状物。结果:共纳入396例患者,占447个襟翼。实施CTA后单侧重建的手术时间明显缩短（p<0.0001）。ICG血管造影显着降低了部分皮瓣丢失（p=0.02）和伤口愈合障碍（p=0.02）的发生率。对于单边重建，在没有合成网状修复的MS1-TRAM皮瓣中更经常观察到腹部膨出或疝（p=0.001），而保守治疗的血清瘤在网状物植入后发生频率更高(p=0.03)。结论：过去几十年来发展的最新技术进步对减少手术持续时间和提高手术安全性产生了重大影响。
