Alexander Germann, Patrick Palines, Hannah Doran, Devin M. Melancon, Hugo St. Hilaire, Robert J. Allen, Mark Stalder
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引用次数: 0
Abstract
Background
With the rising popularity of the deep inferior epigastric perforator (DIEP) flap in breast reconstruction, use of the superficial inferior epigastric vein (SIEV) to augment venous outflow has been proposed as a strategy to prevent venous congestion, a complication positively associated with flap volume. This study evaluated the impact of routine SIEV venous augmentation on the risk of vascular complications or operative fat necrosis in the context of flap size and operating time.
Methods
A retrospective cohort study compared complication rates of patients with SIEV-augmented DIEP flaps to controls over a 3-year period. Outcomes assessed included vascular complications, defined as venous congestion or compromise requiring take-back, partial flap necrosis, total flap loss, as well as operative fat necrosis. Relative risk was modeled by Cox proportional hazard regression analysis. Sensitivity analysis was performed to assess for an interaction effect by flap mass.
Results
The study sample included 197 patients with 316 flaps. The mean mass of the SIEV-augmented flaps was significantly greater than in the control group (832.9 vs. 653.9 g; p = 0.0007). After adjustment for flap characteristics, patient demographic factors, and comorbidities, pooled risk of vascular complication and operative fat necrosis was found to be significantly lower in the SIEV-augmented group compared to controls (hazard ratio = 0.33, 95% CI [0.11–1.00]; p = 0.0489). Sensitivity analysis demonstrated no effect interaction by flap weight (p = 0.5139).
Conclusion
Routine venous outflow augmentation via anastomosis of SIEV to the internal mammary vein perforator at the second intercostal space significantly reduced the risk of vascular complications and operative fat necrosis, regardless of flap weight. No significant increase in operative time was observed among cases in which augmentation was performed.
背景:随着乳房重建中下上腹部深穿孔器(DIEP)皮瓣的普及,使用下上腹部浅静脉(SIEV)增加静脉流出已被提出作为预防静脉充血的一种策略,静脉充血是一种与皮瓣体积正相关的并发症。本研究结合皮瓣大小和手术时间,评估了常规上腹部下静脉扩容对血管并发症或手术脂肪坏死风险的影响:一项回顾性队列研究比较了在3年时间内使用SIEV增强DIEP皮瓣的患者与对照组的并发症发生率。评估的结果包括血管并发症(定义为需要收回的静脉充血或损伤)、部分皮瓣坏死、皮瓣完全脱落以及手术脂肪坏死。通过 Cox 比例危险回归分析建立了相对风险模型。进行了敏感性分析,以评估皮瓣质量的交互效应:研究样本包括197名患者,316个皮瓣。SIEV增强皮瓣的平均质量明显高于对照组(832.9 g vs. 653.9 g; p = 0.0007)。对皮瓣特征、患者人口统计学因素和合并症进行调整后发现,与对照组相比,SIEV增强组发生血管并发症和手术脂肪坏死的总体风险明显较低(危险比 = 0.33,95% CI [0.11-1.00];P = 0.0489)。敏感性分析表明,皮瓣重量不会产生交互影响(p = 0.5139):结论:无论皮瓣重量如何,通过在第二肋间将SIEV与乳内静脉穿孔器吻合来常规增加静脉外流可显著降低血管并发症和手术脂肪坏死的风险。在进行扩容的病例中,手术时间没有明显增加。
期刊介绍:
Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.