PDF(Pubmed)
Abstract：
Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator (PAP) flaps, these procedures are infrequently performed on patients with obesity. This systematic review and meta-analysis aimed to compare the frequency of seroma occurrence, a common complication after medial thigh flap surgery. Comparison was performed between TMG and PAP flaps, as well as medial thigh lifts (MTL), a procedure with a similar operative technique but which is typically offered to patients with a higher body mass index (BMI). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we analyzed EMBASE, PUBMED, and MEDLINE data (English/German). The primary outcomes assessed were occurrence of seroma, as well as hematoma and wound dehiscence. Subgroup analyses explored age, BMI, and various surgical factors. This meta-analysis incorporated 28 studies, totaling 1096 patients. MTL patients had significantly higher BMIs, whereas seroma rates were similar among TMG, PAP, and MTL patients. The incidence of hematoma and wound dehiscence was also similar across the groups. In the metaregression analysis, factors such as age and BMI showed no significant correlation with seroma occurrence in all groups. This systematic review and meta-analysis identified comparable rates of seroma formation after TMG flap, PAP flap, and MTL procedures. Considering that this phenomenon occurred despite the elevated BMI of the MTL group, we propose that patients with higher BMI need not be excluded as candidates for autologous medial thigh-based breast reconstruction. Hence, these procedures should not be limited to small- to medium-sized breasts. Large-scale prospective studies are imperative to validate these conclusions and reveal the underlying factors contributing to seroma formation.
摘要：
尽管越来越多地使用大腿内侧游离皮瓣进行自体乳房重建，如横向上肌腱（TMG）或深动脉穿支（PAP）皮瓣，这些程序很少对肥胖患者进行。这项系统评价和荟萃分析旨在比较血清肿发生的频率，大腿内侧皮瓣手术后的常见并发症。比较TMG和PAP皮瓣，以及内侧大腿举重（MTL），手术技术相似，但通常适用于体重指数（BMI）较高的患者。遵循系统审查和荟萃分析指南的首选报告项目，我们分析了EMBASE,pubmed,和MEDLINE数据（英语/德语）。评估的主要结果是血清肿的发生，还有血肿和伤口裂开.亚组分析探讨了年龄，BMI,和各种手术因素。这项荟萃分析纳入了28项研究，共1096名患者。MTL患者的BMI明显较高，而TMG的血清肿发生率相似，PAP,和MTL患者。各组血肿和伤口裂开的发生率也相似。在回归分析中，年龄和BMI等因素与各组血清肿的发生无显著相关性。这项系统评价和荟萃分析确定了TMG皮瓣后血清肿形成的可比率，PAP襟翼,和MTL程序。考虑到这种现象发生，尽管MTL组的BMI升高，我们建议BMI较高的患者不需要被排除为自体大腿内侧乳房再造的候选人.因此，这些手术不应仅限于中小型乳房。大规模的前瞻性研究必须验证这些结论并揭示导致血清肿形成的潜在因素。
