The Use of Semi-Absorbable Mesh and its Impact on Donor-Site Morbidity and Patient-Reported Outcomes in DIEP Flap Breast Reconstruction.
Breast reconstruction
DIEP
Donor-site morbidity
Hernia
Mesh
Journal
Aesthetic plastic surgery
ISSN: 1432-5241
Titre abrégé: Aesthetic Plast Surg
Pays: United States
ID NLM: 7701756
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
22
09
2020
accepted:
10
12
2020
pubmed:
21
1
2021
medline:
1
6
2021
entrez:
20
1
2021
Statut:
ppublish
Résumé
This study aimed to evaluate the impact of semi-absorbable mesh on donor-site morbidity and patient-reported outcomes in deep inferior epigastric perforator (DIEP) flap breast reconstruction. We conducted a retrospective cohort study of all patients who had DIEP flap breast reconstruction in our department from July 2007 to March 2019. Patients were invited to a comparative follow-up visit and grouped according to donor-site closure: primary fascial closure (the no-mesh group) and fascial reinforcement with semi-absorbable mesh in a subfascial position (the mesh group). The primary outcome of interest was donor-site morbidity, including bulging, hernia formation and rectus abdominis muscle strength. We also surveyed, surgical site complications and patient-reported outcomes using Patient and Observer Scar Assessment Scale v2.0 and BREAST-Q A total of 191 patients had received DIEP flap breast reconstruction. Eighty-five patients (44.5%) with 108 DIEP flaps (53 patients in the mesh group and 32 patients in the no-mesh group) were included in the study. The mean BMI of the patients was significantly higher in the mesh group (mesh group, 26.9 vs. no-mesh group, 25.0, with p = 0.03). The incidence of hernia was significantly reduced in the mesh group (mesh group, 2.8% vs. no-mesh group, 13.5%, with p = 0.03). The incidence of bulging and the extent of rectus abdominis muscle strength were similar for both groups. Operative surgical site complications were reduced in the mesh group (mesh group, 7.5% vs. no-mesh group, 18.8%). There was no difference in patients' physical well-being and satisfaction with the donor site between groups. Patient-reported scar outcome was significantly better in the no-mesh group (p < 0.001). Our novel method of donor-site closure with semi-absorbable mesh in a subfascial position for reinforcement of the anterior rectus fascia on the DIEP donor site is safe. It has no negative impact on surgical site complications and patient-reported outcomes, while reducing the incidence of hernias on the donor-site in DIEP flap breast reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Sections du résumé
BACKGROUND
This study aimed to evaluate the impact of semi-absorbable mesh on donor-site morbidity and patient-reported outcomes in deep inferior epigastric perforator (DIEP) flap breast reconstruction.
METHODS
We conducted a retrospective cohort study of all patients who had DIEP flap breast reconstruction in our department from July 2007 to March 2019. Patients were invited to a comparative follow-up visit and grouped according to donor-site closure: primary fascial closure (the no-mesh group) and fascial reinforcement with semi-absorbable mesh in a subfascial position (the mesh group). The primary outcome of interest was donor-site morbidity, including bulging, hernia formation and rectus abdominis muscle strength. We also surveyed, surgical site complications and patient-reported outcomes using Patient and Observer Scar Assessment Scale v2.0 and BREAST-Q
RESULTS
A total of 191 patients had received DIEP flap breast reconstruction. Eighty-five patients (44.5%) with 108 DIEP flaps (53 patients in the mesh group and 32 patients in the no-mesh group) were included in the study. The mean BMI of the patients was significantly higher in the mesh group (mesh group, 26.9 vs. no-mesh group, 25.0, with p = 0.03). The incidence of hernia was significantly reduced in the mesh group (mesh group, 2.8% vs. no-mesh group, 13.5%, with p = 0.03). The incidence of bulging and the extent of rectus abdominis muscle strength were similar for both groups. Operative surgical site complications were reduced in the mesh group (mesh group, 7.5% vs. no-mesh group, 18.8%). There was no difference in patients' physical well-being and satisfaction with the donor site between groups. Patient-reported scar outcome was significantly better in the no-mesh group (p < 0.001).
CONCLUSION
Our novel method of donor-site closure with semi-absorbable mesh in a subfascial position for reinforcement of the anterior rectus fascia on the DIEP donor site is safe. It has no negative impact on surgical site complications and patient-reported outcomes, while reducing the incidence of hernias on the donor-site in DIEP flap breast reconstruction.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Identifiants
pubmed: 33469702
doi: 10.1007/s00266-020-02096-0
pii: 10.1007/s00266-020-02096-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
907-916Commentaires et corrections
Type : CommentIn
Références
Nahabedian MY, Tsangaris T, Momen B (2005) Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference? Plast Reconstr Surg 115(2):436–444 (discussion 445–6)
doi: 10.1097/01.PRS.0000149404.57087.8E
Chang EI et al (2013) Comprehensive analysis of donor-site morbidity in abdominally based free flap breast reconstruction. Plast Reconstr Surg 132(6):1383–1391
doi: 10.1097/PRS.0b013e3182a805a3
Jeong W, Lee S, Kim J (2018) Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. Breast 38:45–51
doi: 10.1016/j.breast.2017.12.003
Seal SKF et al (2018) Preoperative and postoperative assessment of rectus abdominis muscle size and function following DIEP flap surgery. Plast Reconstr Surg 141(5):1261–1270
doi: 10.1097/PRS.0000000000004297
Han HH et al (2018) Volume change in the rectus abdominis muscle after deep inferior epigastric perforator flap harvest. J Plast Reconstr Aesthet Surg 71(9):1310–1316
doi: 10.1016/j.bjps.2018.06.003
Nahabedian MY, Momen B (2005) Lower abdominal bulge after deep inferior epigastric perforator flap (DIEP) breast reconstruction. Ann Plast Surg 54(2):124–129
doi: 10.1097/01.sap.0000147174.31409.3a
Futter CM et al (2000) A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap. Br J Plast Surg 53(7):578–583
doi: 10.1054/bjps.2000.3427
Tomouk T et al (2017) Donor site morbidity in DIEP free flap breast reconstructions: a comparison of unilateral, bilateral, and bipedicled surgical procedure types. J Plast Reconstr Aesthet Surg 70(11):1505–1513
doi: 10.1016/j.bjps.2017.05.044
Ingvaldsen CA et al (2017) donor-site morbidity after DIEAP flap breast reconstruction-a 2-year postoperative computed tomography comparison. Plast Reconstr Surg Glob Open 5(7):e1405
doi: 10.1097/GOX.0000000000001405
Jordan SW et al (2019) comparison of polypropylene and bioabsorbable mesh for abdominal wall reinforcement following microsurgical breast reconstruction. J Reconstr Microsurg 35(5):335–340
doi: 10.1055/s-0038-1676470
Licari L et al (2019) clinical and functional outcome after abdominal wall incisional hernia repair: evaluation of quality-of-life improvement and comparison of assessment scales. World J Surg 43(8):1914–1920
doi: 10.1007/s00268-019-05003-0
Wan DC et al (2010) Inclusion of mesh in donor-site repair of free TRAM and muscle-sparing free TRAM flaps yields rates of abdominal complications comparable to those of DIEP flap reconstruction. Plast Reconstr Surg 126(2):367–374
doi: 10.1097/PRS.0b013e3181de1b7e
Nelson JA et al (2019) Function and strength after free abdominally based breast reconstruction: a 10-year follow-up. Plast Reconstr Surg 143(1):22e–31e
doi: 10.1097/PRS.0000000000005096
Lee SJ et al (2004) Changes in the local morphology of the rectus abdominis muscle following the DIEP flap: an ultrasonographic study. Br J Plast Surg 57(5):398–405
doi: 10.1016/j.bjps.2003.12.014
Pusic AL et al (2009) Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 124(2):345–353
doi: 10.1097/PRS.0b013e3181aee807
Lee BT et al (2010) A new classification system for muscle and nerve preservation in DIEP flap breast reconstruction. Microsurgery 30(2):85–90
pubmed: 20084669
Healy C, Allen RJ Sr (2014) The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 30(2):121–125
pubmed: 24163223
Duchateau J, Declety A, Lejour M (1988) Innervation of the rectus abdominis muscle: implications for rectus flaps. Plast Reconstr Surg 82(2):223–228
doi: 10.1097/00006534-198808000-00001
Vyas RM et al (2008) Risk factors for abdominal donor-site morbidity in free flap breast reconstruction. Plast Reconstr Surg 121(5):1519–1526
doi: 10.1097/PRS.0b013e31816b1458
Shubinets V et al (2016) Surgically treated hernia following abdominally based autologous breast reconstruction: prevalence, outcomes, and expenditures. Plast Reconstr Surg 137(3):749–757
doi: 10.1097/01.prs.0000479931.96538.c5
Bendavid R (2017) Mesh abdominal wall hernia surgery is safe and effective-the harm New Zealand media has done: response to Dr Steven Kelly’s article. N Z Med J 130(1467):97–98
pubmed: 29240749
Wormer BA et al (2017) Reducing postoperative abdominal bulge following deep inferior epigastric perforator flap breast reconstruction with onlay monofilament poly-4-hydroxybutyrate biosynthetic mesh. J Reconstr Microsurg 33(1):8–18
doi: 10.1055/s-0036-1586495
Jordan SW et al (2018) Implant porosity and the foreign body response. Plast Reconstr Surg 141(1):103e–112e
doi: 10.1097/PRS.0000000000003930
Rosch R et al (2003) Vypro II mesh in hernia repair: impact of polyglactin on long-term incorporation in rats. Eur Surg Res 35(5):445–450
doi: 10.1159/000072230
Klinge U et al (1998) Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall. Eur J Surg 164(12):951–960
doi: 10.1080/110241598750005138
Klinge U et al (2002) Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res 103(2):208–214
doi: 10.1006/jsre.2002.6358
Junge K et al (2002) Functional and morphologic properties of a modified mesh for inguinal hernia repair. World J Surg 26(12):1472–1480
doi: 10.1007/s00268-002-6444-z
Boehmler, J.H. et al (2009) Outcomes of various techniques of abdominal fascia closure after TRAM flap breast reconstruction. Plast Reconstr Surg 123(3):773–781
doi: 10.1097/PRS.0b013e318199ef4f
Stecco C et al (2018) Rectus abdominis muscle innervation: an anatomical study with surgical implications in diep flap harvesting. Surg Radiol Anat 40(8):865–872
doi: 10.1007/s00276-017-1944-6
Grunherz L et al (2020) Donor site aesthetics and morbidity after DIEP flap breast reconstruction-A retrospective multicenter study. Breast J 26:1980–1986
doi: 10.1111/tbj.14003
Christie B et al (2019) Divulge the bulge: an international survey of abdominal donor site morbidity in free autologous breast reconstruction. J Plast Surg Hand Surg 53(5):265–270
doi: 10.1080/2000656X.2019.1597372
Tonseth KA et al (2005) Ultrasonographic evaluation of the rectus abdominis muscle after breast reconstruction with the DIEP flap. Ann Plast Surg 54(5):483–486
doi: 10.1097/01.sap.0000158069.42780.7e
Erdmann-Sager J et al (2018) Complications and patient-reported outcomes after abdominally based breast reconstruction: results of the mastectomy reconstruction outcomes consortium study. Plast Reconstr Surg 141(2):271–281
doi: 10.1097/PRS.0000000000004016
Gao M et al (2010) Vypro II mesh for inguinal hernia repair: a meta analysis of randomized controlled trials. Ann Surg 251(5):838–842
doi: 10.1097/SLA.0b013e3181cc989b
Lee CN, Hultman CS, Sepucha K (2010) What are patients’ goals and concerns about breast reconstruction after mastectomy? Ann Plast Surg 64(5):567–569
doi: 10.1097/SAP.0b013e3181bffc9b