背景:自体乳房重建后腹部供体部位的发病率很常见,而且经常被低估。这项工作旨在比较前瞻性收集的手术和患者因素的技术细节及其对有症状和无症状腹部凸起(ASB和SB)发展的影响。
方法:对2012年5月至2017年10月由两名外科医生在一个机构接受腹部自体乳房再造的患者进行了回顾。人口统计,既往病史和手术史,术中数据,收集术后病程。感兴趣的主要结果是ASB或SB和伤口愈合并发症。
结果:总体而言,包括117例患者的196个游离皮瓣。平均随访1.9±1.7年。13例(11.1%)患者发生ASB,13例(11.1%)患者发展为SB。BMI≥30的患者,双侧ms-TRAM重建,上覆式腹部闭合为2倍,2.3×,8.1倍更有可能出现凸起,分别为(p=0.017,p=0.010,p=0.049)。BMI在30以上每增加1个百分点,形成凸起的几率就会增加10.8%。先前的腹部手术使SB的风险增加了7倍(p=0.017)。收获的肌肉的大小,使用网格,或神经保存不影响膨出发育的速度。
结论:高BMI,双边ms-TRAM,内嵌式腹部闭合,先前的腹部手术会不同程度地增加ASB和SB发展的风险,而其他几个手术变量似乎并没有什么不同。乳房重建患者可以使用这些信息进行术前咨询和术中决策。
Abdominal donor site morbidity after autologous breast reconstruction is common and often underreported. This work aims to compare prospectively collected technical details of the procedure and patient factors and their impact on the development of symptomatic and asymptomatic abdominal bulges (ASB and SB).
A review of patients undergoing abdominal-based autologous breast reconstruction from May 2012 to October 2017 by two surgeons at a single institution was performed. Demographics, prior medical and surgical history, intraoperative data, and postoperative course were collected. Primary outcomes of interest were ASB or SB and wound healing complications.
Overall, 196 free flaps from 117 patients were included. The average follow-up was 1.9 ± 1.7 years. Thirteen (11.1%) patients developed ASB, and 13 (11.1%) patients developed SB. Patients with BMI ≥ 30, bilateral ms-TRAM reconstruction, and an onlay type of abdominal closure were 2×, 2.3×, and 8.1× more likely to develop a
bulge, respectively (p = 0.017, p = 0.010, p = 0.049). Every one-point increase in BMI above 30 increased the odds of developing a
bulge by 10.8%. Prior abdominal surgery increased the risk of SB by 7-fold (p = 0.017). The size of the harvested muscle, use of mesh, or nerve preservation did not affect the rate of
bulge development.
High BMI, bilateral ms-TRAM, onlay type of abdominal closure, and prior abdominal surgery increase the risk of ASB and SB development to varying degrees, while several other operative variables did not seem to make a difference. Breast reconstruction patients can use this information for preoperative counseling and intraoperative decision-making.