Latissimus dorsi myocutaneous reconstruction: a study of long-term outcomes in a district general hospital.
Latissimus dorsi myocutaneous reconstruction: a study of long-term outcomes in a district general hospital.
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背阔肌肌皮重建：地区综合医院长期结果的研究。
DOI：
10.1308/rcsann.2016.0311
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发表时间：
2016
影响因子：
1.4
通讯作者：
Richard Sutton
中科院分区：
文献类型：
--
作者：
C. Kallaway;Alexandra Humphreys;N. Laurence;Richard Sutton
引言本研究的目的是评估在一家地区综合医院进行的自体和植入物辅助背阔肌重建的长期结果和耐久性，随访时间为10年。方法：使用2003年至2013年在巴斯皇家联合医院由一名顾问外科医生进行的所有背阔肌皮瓣重建的详细数据库进行了一项前瞻性队列研究。重建后的长期结果进行了评估，分析所有事件的“重建特定”的操作，从6个月后的首次手术。结果：110例患者采用背阔肌皮瓣重建，21例为自体，95例为种植辅助。对27例再造皮瓣进行了放射治疗。平均随访时间为69个月。27例（23%）需要进一步重建特定手术，其中5例为放疗后皮瓣。植入物相关手术是进一步手术的最常见原因。植入物本身的并发症占这些病例的52%，慢性脓毒症是最常见的。需要进一步手术的症状性包囊挛缩发生率为4.2%。其中，四名患者中有一名接受了放疗。讨论在我们的机构，背阔肌重建是持久和安全的长期，与有限的需要进一步实质性干预，以保持良好的结果，从最初的重建。与植入重建相比，自体皮瓣不太可能需要长期的进一步手术。有症状的包膜挛缩发生率较低可能是由于所使用的延长收获皮瓣提供了保护机制。
INTRODUCTION The aim of this study was to evaluate the long-term outcome and durability of both autologous and implant-assisted latissimus dorsi reconstruction in a district general hospital over a 10-year follow-up period. METHODS A prospective cohort study was carried out using a detailed database of all latissimus dorsi flap reconstructions performed by a single consultant surgeon between 2003 and 2013 at the Royal United Hospital, Bath. The long-term outcome following reconstruction was assessed by analysing all episodes of 'reconstruction-specific' operations required from 6 months after the initial surgery. RESULTS The study included 110 patients with latissimus dorsi flap reconstructions, 21 autologous and 95 implant-assisted. Radiotherapy was given to 27 patients with reconstructed flaps. Mean follow-up was 69 months. Further reconstruction-specific surgery was needed in 27 (23%) cases, with 5 of these being post-radiotherapy flaps. Implant-related surgery was the most common reason for further surgery. Complications of the implant itself made up 52% of these cases, chronic sepsis being the most common. The rate of symptomatic capsular contracture requiring further surgery was 4.2%. Of these, one of four patients had undergone radiotherapy. DISCUSSION In our institution, latissimus dorsi reconstruction is durable and safe over the long term, with limited need for further substantial intervention to maintain a good outcome from the initial reconstruction. Autologous flaps were less likely to require further surgery over the long term compared with implant-based reconstructions. The low rate of symptomatic capsular contracture may be due to the protective mechanism provided by the extended harvest flap used.