[Impact of the number of pregnancies on the venous outflow of DIEP flap in breast reconstruction: A clinical and CT-scan study].

IF 0.4 4区 医学 Q4 SURGERY Annales De Chirurgie Plastique Esthetique Pub Date : 2024-10-23 DOI:10.1016/j.anplas.2024.10.001
I Hadji, G Roccaro, L Ferrero, F Pigneur, B Hersant, J-P Meningaud
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Abstract

Introduction: The DIEP (deep inferior epigastric perforator) flap is the "gold standard" for breast reconstruction after cancer, giving better benefits on the quality of life. The most common complication is the venous congestion, because of the dominance of superficial venous outflow while the flap is drained by the deep epigastric vein. Pregnancy, by its physiological and vascular modifications, can reduce the risk of the venous congestion. Few studies explored the impact of pregnancy on the DIEP vascularization.

Material and methods: We studied the preoperative CT-scans of 104 patients who benefited reconstruction surgery by DIEP from January 2011 until March 2022. The patients were separated into 5 groups according to number of pregnancies. For each CT-scan, a concomitant vein of deep epigastric artery diameter/SIEV diameter ratio was performed on each side, to assess the relation between pregnancy and the reduction of venous complications.

Results: The results showed an increase of this ratio with the number of pregnancies. Patients with no pregnancy (G0) have the highest complication rate, with 41.7% of venous congestion case. On the other hand, in the group of four pregnancies or more (G4), the complication rate was significantly lower, at 10%, and none venous congestion was observed. These results suggest the beneficial effects of pregnancy on vascularization and especially on venous drainage in the DIEP flap.

Conclusion: This study highlights the benefit effect of the number of pregnancies on the DIEP vascularization, especially for the reduction of the venous congestion risk. The ratio DIEV/SIEV may be a useful help to predict the risk of venous complications in nullparous patients. These results open to new studies to deepen the understanding of the physiological effects of the pregnancy on the breast reconstruction surgery.

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[妊娠次数对乳房再造中 DIEP 皮瓣静脉流出的影响:临床和 CT 扫描研究]。
简介DIEP(上腹部深静脉穿孔)皮瓣是癌症术后乳房再造的 "金标准",能更好地提高生活质量。最常见的并发症是静脉充血,因为皮瓣由上腹部深静脉引流,而浅静脉流出占主导地位。妊娠期的生理和血管变化可降低静脉充血的风险。很少有研究探讨妊娠对 DIEP 血管化的影响:我们对 2011 年 1 月至 2022 年 3 月期间接受 DIEP 重建手术的 104 例患者的术前 CT 扫描进行了研究。根据妊娠次数将患者分为 5 组。在每次CT扫描中,对两侧上腹深动脉的伴行静脉直径/SIEV直径进行比对,以评估妊娠与静脉并发症减少之间的关系:结果显示,随着妊娠次数的增加,该比率也随之增加。未妊娠患者(G0)的并发症发生率最高,静脉充血病例占 41.7%。另一方面,四次或四次以上妊娠组(G4)的并发症发生率明显较低,仅为 10%,且未观察到静脉充血。这些结果表明,妊娠对 DIEP 皮瓣的血管化,尤其是静脉引流有好处:本研究强调了妊娠次数对 DIEP 血管化的有益影响,尤其是降低了静脉充血风险。DIEV/SIEV之比可能有助于预测空腹患者发生静脉并发症的风险。这些研究结果为加深了解妊娠对乳房重建手术的生理影响提供了新的研究思路。
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来源期刊
CiteScore
1.00
自引率
0.00%
发文量
86
审稿时长
44 days
期刊介绍: Qu''elle soit réparatrice après un traumatisme, pratiquée à la suite d''une malformation ou motivée par la gêne psychologique dans la vie du patient, la chirurgie plastique et esthétique touche toutes les parties du corps humain et concerne une large communauté de chirurgiens spécialisés. Organe de la Société française de chirurgie plastique reconstructrice et esthétique, la revue publie 6 fois par an des éditoriaux, des mémoires originaux, des notes techniques, des faits cliniques, des actualités chirurgicales, des revues générales, des notes brèves, des lettres à la rédaction. Sont également présentés des analyses d''articles et d''ouvrages, des comptes rendus de colloques, des informations professionnelles et un agenda des manifestations de la spécialité.
期刊最新文献
LIPOPULP. The impact of fat grafting on pulp sensitivity in fingertip injuries: A retrospective study of seven patients. Using 320-slice computed tomography to preoperatively investigate the leg perforator arterial system and design a perforator flap for patients with a soft-tissue defect in the leg. [Cutaneous and subcutaneous primary leiomyosarcoma: A retrospective cohort of 26 cases examining clinical data and treatments]. [Impact of the number of pregnancies on the venous outflow of DIEP flap in breast reconstruction: A clinical and CT-scan study]. [Using a smartphone-compatible thermal camera (FLIR One) for preoperative mapping of DIEP perforators].
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