Complications Of Breast Reconstruction With Deep Inferior Epigastric Perforator Flap And Pedicled Transverse Rectus Abdominis Myocutaneous Flap:A Meta-Analysis

Background of breast reconstruction:Breasts have poor or missing breast shape due to resection of benign and malignant tumors or trauma and congenital dysplasia.Poor breast morphology and loss can lead to female body shape defects and psychological trauma.The above problems can be solved by breast reconstruction techniques.In 1906 Tansini first used the latissimus dorsi musculocutaneous flap for breast reconstruction.In 1977,McCraw established the theory of blood supply for myocutaneous flaps,which laid the foundation for the wide application of post-facial flap reconstruction(1).Up to now,as many as 10 types of surgical procedures have been established in breast reconstruction,but the most common types of operation are:abdominal perforator flaps,transverse rectus abdominis flaps,latissimus dorsi myocutaneous flaps,and prosthetic joint lats valve.As early as 1979,Robbins et al.used verticle rectus abdominis myocutaneous(VRAM)for breast reconstruction.Three years later,Hartrampf et al.modified this method,transversing rectus abdominis flaps(transverse rectus abdominis).Muscle,TRAM)was used for breast reconstruction(2,3).Because the TRAM is relatively simple to operate and has a large amount of tissue,it is a good choice for surgeons and patients.With the development of breast reconstruction,Koshima gave priority to the deep inferior epigastric perforator flap in 1989.Allen et al.used it successfully in breast reconstruction in 1994 and was promoted and used.The "DIEP" flap(4,5).The inferior epigastric artery perforator flap(DIEP)is an improvement of the TRAM,but its operation is relatively fine,requiring higher surgeons and longer operation time.These two types of surgical procedures have been used for decades and it is still controversial which type of surgical procedure is more advantageous.I analyzed the main complications of the DIEP and PTRAM for breast reconstruction and the donor site based on the collected literature,reflecting the pros and cons of the two surgical procedures from the side and providing decision-making for the clinicians to the surgeons.Gives surgeons a good guide.Objective:To analyze the complication of breast reconstruction with deep inferior epigastric perforator flap and Pedicled transverse rectus abdominis myocutaneous flap.provide the basis for clinicians in the surgical decision making.Methods:Retrieval in the PubMed database,Cochrane Library,China HowNet(CNKI),VIP,Wanfang etc.online databases from January 1990 to January 2018 Breast reconstruction of the inferior epigastric artery perforator flap and pedicled rectus abdominis myocutaneous flap And English literature,according to inclusion and exclusion criteria for selecting documents,extracting data and quality evaluation.The original literature included the comparison of the breast reconstruction with the inferior epigastric artery perforator flap and the pedicled transverse rectus abdominis flap.Data statistical analysis using Revman 5.3 software,using a random or fixed-effect model for fat necrosis rate,partial flap necrosis rate,total flap necrosis rate,postoperative infection rate,seroma rate and abdominal hernia rate meta-analysis.Results:1488 articles were initially identified.Through reading abstracts,1406 articles including systematic reviews,case reports,newsletters,review,surgical techniques,animal experiments,anatomy studies,non-related statistical data,and languagesother than English or Chinese were excluded.Further reading of the full text,69 articles that did not meet the inclusion criteria were excluded and 13 articles were included.All 13 articles were retrospective clinical case-control studies.The incidence of fat necrosis in DIEP and PTRAM breast reconstruction areas was OR=0.77,95%CI[0.41,1.44],Z=0.82(P=0.41),suggesting that there was no significant difference in fat necrosis between DIEP and PTRAM group.The incidence of partial flap necrosis was OR = 0.80,95%CI[0.56,1.14],Z = 1.25(P = 0.21),suggesting that there was no significant difference in partial flap necrosis between the DIEP and PTRAM groups;the flaps were completely The incidence of necrosis was OR = 1.44,95%CI[0.82,2.53],Z = 1.26(P = 0.21),suggesting that there was no significant difference in the number of complete necrosis of the flap between DIEP and PTRAM;the incidence of postoperative wound infection OR=0.39,95%CI[0.29,0.53],Z=5.93(P<0.00001),suggesting that the wound infection rate after DIEP was lower than that in the P-TRAM group;the incidence of seroma was OR=0.49,95%CI[0.36,0.68],Z=4.32(P<0.0001),suggesting that the incidence of seroma in the DIEP group was lower than in the PTRAM group;the incidence of abdominal wall hernia was OR=0.17,95%CI[0.10,0.30],Z=6.30(P<0.00001),suggesting that the incidence of abdominal hernia was lower in the DIEP group than in the PTRAM group.Conclusions:There was no statistically significant difference in the incidence of fat necrosis,partial flap necrosis,and complete flap necrosis between the inferior epigastric perforator flap and the pedicled rectus abdominis flap.The incidence of wound infection and the incidence of seroma after flap breast reconstruction was lower than that of the pedicled rectus abdominis flap.the incidence of abdominal hernia was lower in the DIEP group than in the PTRAM group.According to the statistical results of complications,the breast reconstruction of the inferior epigastric artery perforator flap is better than the pedicle transverse rectus abdominis flap breast reconstruction.