Farrah C Liu, Daniel Najafali, Dung Nguyen, Arash Momeni
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Group 1 consisted of patients who underwent polypropylene sublay-onlay (\"sandwich\") mesh placement (<i>N</i> = 70) versus polypropylene sublay-only mesh (group 2; <i>N</i> = 54) versus primary fascial repair without mesh (group 3; <i>N</i> = 34).</p><p><strong>Results: </strong> Patient demographics and comorbidities were comparable between study groups, except for rates of neoadjuvant chemotherapy (group 1: 53% vs. group 2: 33% vs. group 3: 24% [<i>p</i> < 0.01]), postoperative follow-up in months (group 1: 21.5; group 2: 11.5; group 3: 7.6 [<i>p</i> < 0.01]), and length of stay in days (group 1: 4.9 vs. group 2: 4.4 vs. group 3: 3.3 [<i>p</i> < 0.01]). No differences were observed in breast flap and donor-site complications between study groups. Patients in group 3 required significantly lower oral morphine equivalent units postoperatively compared with those in groups 1 and 2 (group 1:185.5 vs. group 2: 79.7 vs. group 3: 71.6 [<i>p</i> < 0.01]).</p><p><strong>Conclusion: </strong> Abdominal donor-site closure without mesh was associated with a shorter length of stay and less narcotic intake without an increase in donor-site complications. These findings should be considered when deciding to place mesh for donor-site closure after abdominal flap harvest.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Less Is More: The Role of Mesh in Microsurgical Breast Reconstruction with Abdominal Flaps.\",\"authors\":\"Farrah C Liu, Daniel Najafali, Dung Nguyen, Arash Momeni\",\"doi\":\"10.1055/s-0044-1788929\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong> The use of mesh to reinforce the abdominal wall after abdominal flap harvest has been reported to decrease the risk of bulging and herniation. However, the impact of the plane of mesh placement in relation to the anterior rectus sheath (vs. no mesh) on postoperative abdominal complications remains unclear.</p><p><strong>Methods: </strong> We retrospectively analyzed the length of stay and clinical outcomes in 158 female patients who underwent breast reconstruction with 250 free abdominal flaps. Group 1 consisted of patients who underwent polypropylene sublay-onlay (\\\"sandwich\\\") mesh placement (<i>N</i> = 70) versus polypropylene sublay-only mesh (group 2; <i>N</i> = 54) versus primary fascial repair without mesh (group 3; <i>N</i> = 34).</p><p><strong>Results: </strong> Patient demographics and comorbidities were comparable between study groups, except for rates of neoadjuvant chemotherapy (group 1: 53% vs. group 2: 33% vs. group 3: 24% [<i>p</i> < 0.01]), postoperative follow-up in months (group 1: 21.5; group 2: 11.5; group 3: 7.6 [<i>p</i> < 0.01]), and length of stay in days (group 1: 4.9 vs. group 2: 4.4 vs. group 3: 3.3 [<i>p</i> < 0.01]). No differences were observed in breast flap and donor-site complications between study groups. Patients in group 3 required significantly lower oral morphine equivalent units postoperatively compared with those in groups 1 and 2 (group 1:185.5 vs. group 2: 79.7 vs. group 3: 71.6 [<i>p</i> < 0.01]).</p><p><strong>Conclusion: </strong> Abdominal donor-site closure without mesh was associated with a shorter length of stay and less narcotic intake without an increase in donor-site complications. 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引用次数: 0
摘要
背景:有报道称,腹部皮瓣切除术后使用网片加固腹壁可降低隆起和疝的风险。然而,网片放置平面与前直肌鞘的关系(与无网片相比)对术后腹部并发症的影响仍不清楚:我们回顾性分析了158名接受250个游离腹部皮瓣乳房重建术的女性患者的住院时间和临床结果。结果:患者的人口统计学特征和并发症发生率均有所下降:结果:除新辅助化疗率(第1组:53% vs. 第2组:33% vs. 第3组:24%[p p p p 结论:各研究组的患者人口统计学和合并症具有可比性:不使用网片的腹部供体部位闭合术可缩短住院时间,减少麻醉剂用量,但不会增加供体部位并发症。在决定为腹部皮瓣采集后的供体部位闭合放置网片时,应考虑这些研究结果。
Less Is More: The Role of Mesh in Microsurgical Breast Reconstruction with Abdominal Flaps.
Background: The use of mesh to reinforce the abdominal wall after abdominal flap harvest has been reported to decrease the risk of bulging and herniation. However, the impact of the plane of mesh placement in relation to the anterior rectus sheath (vs. no mesh) on postoperative abdominal complications remains unclear.
Methods: We retrospectively analyzed the length of stay and clinical outcomes in 158 female patients who underwent breast reconstruction with 250 free abdominal flaps. Group 1 consisted of patients who underwent polypropylene sublay-onlay ("sandwich") mesh placement (N = 70) versus polypropylene sublay-only mesh (group 2; N = 54) versus primary fascial repair without mesh (group 3; N = 34).
Results: Patient demographics and comorbidities were comparable between study groups, except for rates of neoadjuvant chemotherapy (group 1: 53% vs. group 2: 33% vs. group 3: 24% [p < 0.01]), postoperative follow-up in months (group 1: 21.5; group 2: 11.5; group 3: 7.6 [p < 0.01]), and length of stay in days (group 1: 4.9 vs. group 2: 4.4 vs. group 3: 3.3 [p < 0.01]). No differences were observed in breast flap and donor-site complications between study groups. Patients in group 3 required significantly lower oral morphine equivalent units postoperatively compared with those in groups 1 and 2 (group 1:185.5 vs. group 2: 79.7 vs. group 3: 71.6 [p < 0.01]).
Conclusion: Abdominal donor-site closure without mesh was associated with a shorter length of stay and less narcotic intake without an increase in donor-site complications. These findings should be considered when deciding to place mesh for donor-site closure after abdominal flap harvest.
期刊介绍:
The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers.
The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases.
The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.