辐照患者乳房切除术后重建：对深下上腹肌穿孔器和背阔肌皮瓣效果的 12 年随访

IF 1.5 Q3 SURGERY

JPRAS Open Pub Date : 2024-10-18 DOI:10.1016/j.jpra.2024.10.008

Åsa Edsander-Nord , Armin Assareh , Martin Halle , Ann-Charlott Docherty Skogh

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引用次数: 0

摘要

本研究的目的是对作者之前评估过的一组接受过乳房切除术后乳房重建术的辐照患者进行为期 12 年的随访，这些患者接受了带假体的深下上腹部穿孔器 (DIEP) 和背阔肌 (LD) 皮瓣重建术。患者报告的结果测量（PROMS）采用 BREAST-Q、SF-36、满意度表以及手臂、肩部和手部残疾（DASH）问卷进行测量。平均随访时间为 12.6 年（DIEP）和 11.8 年（LD）。15 名 DIEP 和 9 名 LD 患者接受了对侧对称手术。两组患者平均接受了 2.5 次重建手术。BREAST-Q 和满意度问卷调查显示两组患者无差异。SF-36 没有显示出组别差异，但与普通人群相比，两组患者在身体角色限制方面的数值明显更高（分别为 p=0.034 和 p=0.004）。美学评估显示，患者和外科医生的意见存在差异，DIEP组患者对重建乳房的大小（p=0.015）和整体美感（p=0.012）的评价更高。加权卡帕分析显示，患者与外科医生之间的一致性较差。随着时间的推移，患者的偏好从LD皮瓣转向DIEP皮瓣，这可能是由于自体重建的自然衰老过程。这强调了长期随访研究的重要性。

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Postmastectomy Breast Reconstruction in Irradiated Patients: A 12-year follow-up of Deep Inferior Epigastric Perforator and Latissimus Dorsi Flap Outcomes

The aim of the current study was to conduct a 12-year follow-up on the authors´ previously evaluated group of irradiated patients who underwent postmastectomy breast reconstruction with deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD)-flaps with implant.

The follow-up involved 67% of the patients from the original cohort (17 DIEP and 13 LD). Patient-reported outcome measures (PROMS) were measured using the BREAST-Q, SF-36, a satisfaction form, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires. Aesthetics were evaluated by a board of independent plastic surgeons.

The average follow-up time was 12.6 years (DIEP) and 11.8 years (LD). Contralateral symmetry procedures were performed on 15 DIEP and 9 LD patients. Both groups underwent an average of 2.5 reconstructive procedures. The BREAST-Q and satisfaction questionnaires showed no group difference. SF-36 showed no group difference but had significantly higher values in both groups compared to the general population with regard to the physical role limitations (p=0.034 and p=0.004, respectively). The DASH scores showed minimal shoulder function impact in the LD group.

Aesthetic evaluations revealed a discrepancy between the opinions of the patients and surgeons, with patients valuing the size (p=0.015) and overall aesthetic (p=0.012) of the reconstructed breast higher in the DIEP group. The weighted kappa analysis showed poor agreement between patients and surgeons. Over time, the patients´ preferences shifted from LD to DIEP flaps, possibly due to the more natural aging process associated with autologous reconstruction. This underscores the importance of long term follow-up studies.

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来源期刊

JPRAS Open Medicine-Surgery

CiteScore

1.60

自引率

0.00%

发文量

审稿时长

22 weeks

期刊介绍： JPRAS Open is an international, open access journal dedicated to publishing case reports, short communications, and full-length articles. JPRAS Open will provide the most current source of information and references in plastic, reconstructive & aesthetic surgery. The Journal is based on the continued need to improve surgical care by providing highlights in general reconstructive surgery; cleft lip, palate and craniofacial surgery; head and neck surgery; skin cancer; breast surgery; hand surgery; lower limb trauma; burns; and aesthetic surgery. The Journal will provide authors with fast publication times.