Single-Pedicled, Supercharged, or Bi-Pedicled? A Multi-Institutional Outcome Comparison of Pedicled TRAM Flap for Autologous Breast Reconstruction.

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer Pub Date : 2025-04-09 DOI:10.1016/j.clbc.2025.03.022

Samuel Knoedler, Dany Y Matar, Thomas Schaschinger, Sam Boroumand, Savas Tsolakidis, Sören Könneker, Dennis P Orgill, Adriana C Panayi, Bong-Sung Kim

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引用次数: 0

Abstract

Introduction: A direct comparison of outcomes among the 3 main types of pedicled TRAM-single-, supercharged, and bi-pedicled-has yet to be conducted.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2008-2022) was analyzed to identify female patients who underwent pedicled TRAM flap breast reconstruction. Patients were stratified by TRAM flap type, and their 30-day postoperative outcomes were compared.

Results: A total of 2022 patients (mean age: 53 ± 9.4 years; mean BMI: 29 ± 6.4 kg/m²) were included, of whom 73% (n = 1473) received single-pedicled, 16% (n = 327) supercharged, and 11% (n = 222) bi-pedicled TRAM flaps. Overall, 433 (21%) patients experienced complications, with 155 (7.7%) surgical and 190 (9.4%) medical complications. Multivariate analysis showed generally comparable outcomes among the 3 types, but bi-pedicled flaps had a higher risk of medical complications (OR: 1.6; P = .04). Smoking, higher ASA classes, and higher BMI were independently associated with the occurrence of any complication (OR: 1.74, P = .001; OR: 1.76, P < .001; OR: 1.04, P < .001), surgical complications (OR: 1.85, P = .01; OR: 1.71, P = .002; OR: 1.035, P = .002), and readmission (OR: 2.54, P < .001; OR: 1.62, P = .02; OR: 1.04, P = .002). Smoking (OR: 2.38, P < .001), higher BMI (OR: 1.03, P = .004), and hypertension (OR: 1.47, P = .02) correlated with an increased likelihood of reoperation.

Conclusion: This study revealed that outcomes after single-, supercharged, and bi-pedicled TRAM flaps are generally comparable. Yet, bi-pedicled TRAM flap reconstruction was seen to be associated with a higher risk of medical complications. Smoking, obesity, higher ASA class, and hypertension were identified as risk factors for adverse events.

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单花梗，增压花梗，还是双花梗？带蒂TRAM皮瓣用于自体乳房再造术的多机构疗效比较。

目前还没有对三种主要带蒂的tram（单蒂、增压式和双蒂）的疗效进行直接比较。方法：分析美国外科医师学会国家外科质量改进计划数据库（2008-2022），确定行带蒂TRAM皮瓣乳房重建术的女性患者。按TRAM皮瓣类型对患者进行分层，比较其术后30天的预后。结果：共纳入患者2022例，平均年龄53±9.4岁；平均BMI: 29±6.4 kg/m2)，其中73% （n = 1473）接受单蒂TRAM皮瓣，16% （n = 327）接受增压皮瓣，11% （n = 222）接受双蒂TRAM皮瓣。总体而言，433例（21%）患者出现并发症，其中155例（7.7%）手术并发症和190例（9.4%）内科并发症。多因素分析显示，三种类型的结果大致相当，但双蒂皮瓣的医疗并发症风险较高(OR: 1.6；P = .04)。吸烟、较高的ASA等级和较高的BMI与任何并发症的发生独立相关(OR: 1.74, P = .001；Or: 1.76, p < 0.001；OR: 1.04, P < 0.001)，手术并发症(OR: 1.85, P = 0.01；Or: 1.71, p = 0.002；OR: 1.035, P = 0.002)，再入院率(OR: 2.54, P < 0.001；或：1.62,p = .02；或：1.04,p = .002)。吸烟（OR: 2.38, P < .001）、较高的BMI （OR: 1.03, P = .004）和高血压（OR: 1.47, P = .02）与再次手术的可能性增加相关。结论：本研究表明，单蒂、增压皮瓣和双蒂TRAM皮瓣的结果大致相当。然而，双蒂TRAM皮瓣重建被认为与较高的医学并发症风险相关。吸烟、肥胖、较高的ASA等级和高血压被确定为不良事件的危险因素。

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来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.