The Impact of Perforator Number on Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Grover, Ritwik; Nelson, Jonas A.; Fischer, John P.; Kovach, Stephen J.; Serletti, Joseph M.; Wu, Liza C.

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자료유형: 학술저널

저자정보: Grover, Ritwik (Division of Plastic Surgery, Hospital of the University of Pennsylvania) Nelson, Jonas A. (Division of Plastic Surgery, Hospital of the University of Pennsylvania) Fischer, John P. (Division of Plastic Surgery, Hospital of the University of Pennsylvania) Kovach, Stephen J. (Division of Plastic Surgery, Hospital of the University of Pennsylvania) Serletti, Joseph M. (Division of Plastic Surgery, Hospital of the University of Pennsylvania) Wu, Liza C. (Division of Plastic Surgery, Hospital of the University of Pennsylvania)

저널정보: 대한성형외과학회 Archives of plastic surgery : APS Archives of plastic surgery : APS 제41권 제1호

발행연도: 2014.1

수록면: 63 - 70 (8page)

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Background Perforator flaps minimize abdominal site morbidity during autologous breast reconstruction. The purpose of this study was to assess whether the number of perforators harvested influences the overall deep inferior epigastric perforator (DIEP) flap survival and flap-related complications. Methods A retrospective review was performed of all DIEP flaps performed at the Hospital of the University of Pennsylvania from 2006 to 2011. The outcomes assessed included flap loss and major complications. We compared flaps by the number of total perforators (1-4) and then carried out a subgroup analysis comparing flaps with one perforator to flaps with multiple perforators. Lastly, we conducted a post-hoc analysis based on body mass index (BMI) categorization. Results Three hundred thirty-three patients underwent 395 DIEP flaps. No significant differences were noted in the flap loss rate or the overall complications across perforator groups. However, the subgroup analysis revealed significantly higher rates of fat necrosis in the case of one-perforator flaps than in the case of multiple-perforator flaps (10.2% vs. 3.1%, P=0.009). The post-hoc analysis revealed a significant increase in the flap loss rate with increasing BMI (<30=2.0%, 30-34.9=3.1%, 35-39.9=3.1%, >40=42.9%, P<0.001) in the DIEP flaps, but no increase in fat necrosis. Conclusions This study demonstrates that the number of perforators does not impact the rate of flap survival. However, the rate of fat necrosis may be significantly higher in DIEP flaps based on a single perforator. Multiple perforators should be utilized if possible to decrease the risk of fat necrosis.

#Breast reconstruction #Outcome assessment #health care) #Microsurgery

참고문헌 (20)

참고문헌 신청

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Selber JC / 2010 / A prospective study com-paring the functional impact of SIEA, DIEP, and muscle-spar-ing free TRAM flaps on the abdominal wall: part I. unilateral reconstruction / Plast Reconstr Surg 126:1142~1153

Selber JC / 2010 / A prospective study com-paring the functional impact of SIEA, DIEP, and muscle-spar-ing free TRAM flaps on the abdominal wall: Part II. Bilateral reconstruction / Plast Reconstr Surg 126:1438~1453