Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels

J. Palve, T. Luukkaala, M. Kääriäinen
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Abstract

Abstract Background The aim of this study is to analyze the impact of the number and location of perforators harvested and the recipient vessels used on deep inferior epigastric perforator (DIEP) flap survival and the occurrence of flap necrosis requiring re-operation. Patients and Methods Four hundred and seventy-one DIEP flap reconstructions, performed between January 2008 and December 2019, were retrospectively analyzed. Results Flap necrosis requiring re-operation was observed in 40 (9%) of flaps and total flap loss rate was 1% (n = 6). No significant differences were observed between internal mammary vessels (IMV, n = 287, 61%) and thoracodorsal vessels (TDV, n = 184, 39%) regarding postoperative re-anastomosis (p = 0.529) or flap survival (p = 0.646). Intraoperative conversion from IMV to TDV was performed on 64 (14%) patients. TDV were more commonly associated with problems in preparation of the vessels than IMV (p < 0.001). Second vein anastomosis was performed on 18 (4%) patients. In total, 81 flaps (17%) had one perforator, 165 (35%) had two, 218 (46%) had three to five, and 7 (2%) had more than five perforators. Flaps with three to five perforators were more commonly associated with flap necrosis (p < 0.001) than flaps with one or two perforators. Independent factors associated with necrosis were body mass index (BMI) > 30 (odds ratio [OR]: 2.28; 95% confidence interval: 1.06–4.91, p = 0.035) and perforator/s located on the lateral row (OR: 3.08, 95% CI 1.29–7.33, p = 0.011). Conclusion We conclude that the occurrence of flap necrosis requiring re-operation may be higher in DIEP flaps with more than two perforators or perforator/s located on the lateral row and in obese patients. Neither the recipient vessels used nor the number of perforators harvested had any impact on the flap survival rate.
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腹下深穿支重建后皮瓣坏死或缺损:对穿支和受体血管的影响
摘要背景 本研究的目的是分析采集的穿支和受体血管的数量和位置对上腹部下穿支(DIEP)皮瓣存活和需要再次手术的皮瓣坏死发生的影响。患者和方法 对2008年1月至2019年12月期间进行的四百七十一次DIEP皮瓣重建进行了回顾性分析。后果 40例(9%)皮瓣坏死需要再次手术,皮瓣总丢失率为1%(n = 6) 。乳腺内部血管(IMV = 287,61%)和胸背血管(TDV = 18439%)(p = 0.529)或皮瓣存活率(p = 0.646)。64名(14%)患者在术中从IMV转换为TDV。TDV比IMV更常与血管准备问题相关(p  30(比值比[OR]:2.28;95%置信区间:1.06–4.91,p = 0.035)和位于侧行的射孔器/s(OR:3.08,95%CI 1.29–7.33,p = 0.011)。结论 我们的结论是,在侧行有两个以上穿支或穿支的DIEP皮瓣和肥胖患者中,需要再次手术的皮瓣坏死发生率可能更高。无论是使用的受体血管还是收获的穿孔器的数量都对皮瓣的存活率没有任何影响。
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发文量
6
审稿时长
14 weeks
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