BACKGROUND: Countless studies have compared the use of autologous tissue for breast reconstruction; however, rates of donor-site morbidity differ greatly. This study examined the donor-site morbidity of superficial inferior epigastric artery (SIEA), deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps when used for unilateral breast reconstruction. METHODS: Searches in PubMed and Medline as well as three manual search strategies for English-language articles published from 1 January 1995 to 1 January 2011 resulted in 2154 publications. Four levels of screening identified five studies suitable for the meta-analysis. StatsDirect software was used to perform the Mantel-Haenszel fixed-effect model. RESULTS: Only one study reported rates of donor-site morbidity for SIEA flaps. It was therefore impossible to perform any analysis regarding SIEA flaps. Five studies reported rates for both DIEP and MS-TRAM flaps and were used to estimate pooled relative risk (RR) and confidence intervals (CIs) of bulging. There was a 20% reduced risk of bulging when DIEP flaps were used compared to MS-TRAM flaps (RR 0.80, 95% CI 0.48-1.35). Subgroup analysis demonstrated that the risk of bulging in DIEP flap patients was one-third of MS-TRAM flap patients (RR 0.29; 95% CI 0.06-1.36), when rates were reported by clinical examinations. However, when rates were reported by surveys there was no difference in bulge formation between DIEP and MS-TRAM flap patients (RR 1.04; 95% CI 0.59-1.79). The adjusted RR of hernia in DIEP flap patients was approximately one-half of MS-TRAM flap patients (RR 0.43; 95% CI 0.07-2.63). CONCLUSION: This analysis demonstrated a clear trend towards a favourable outcome when DIEP flaps were used compared to MS-TRAM flaps.
BACKGROUND: Countless studies have compared the use of autologous tissue for breast reconstruction; however, rates of donor-site morbidity differ greatly. This study examined the donor-site morbidity of superficial inferior epigastric artery (SIEA), deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps when used for unilateral breast reconstruction. METHODS: Searches in PubMed and Medline as well as three manual search strategies for English-language articles published from 1 January 1995 to 1 January 2011 resulted in 2154 publications. Four levels of screening identified five studies suitable for the meta-analysis. StatsDirect software was used to perform the Mantel-Haenszel fixed-effect model. RESULTS: Only one study reported rates of donor-site morbidity for SIEA flaps. It was therefore impossible to perform any analysis regarding SIEA flaps. Five studies reported rates for both DIEP and MS-TRAM flaps and were used to estimate pooled relative risk (RR) and confidence intervals (CIs) of bulging. There was a 20% reduced risk of bulging when DIEP flaps were used compared to MS-TRAM flaps (RR 0.80, 95% CI 0.48-1.35). Subgroup analysis demonstrated that the risk of bulging in DIEP flap patients was one-third of MS-TRAM flap patients (RR 0.29; 95% CI 0.06-1.36), when rates were reported by clinical examinations. However, when rates were reported by surveys there was no difference in bulge formation between DIEP and MS-TRAM flap patients (RR 1.04; 95% CI 0.59-1.79). The adjusted RR of hernia in DIEP flap patients was approximately one-half of MS-TRAM flap patients (RR 0.43; 95% CI 0.07-2.63). CONCLUSION: This analysis demonstrated a clear trend towards a favourable outcome when DIEP flaps were used compared to MS-TRAM flaps.
Authors: Jonas A Nelson; Michael G Tecci; Michael A Lanni; John P Fischer; Joshua Fosnot; Jesse C Selber; Liza C Wu; Joseph M Serletti Journal: Plast Reconstr Surg Date: 2019-01 Impact factor: 4.730
Authors: Daniel R Leff; Alex Bottle; Erik Mayer; Darren K Patten; Christopher Rao; Paul Aylin; Dimitri J Hadjiminas; Thanos Athanasiou; Ara Darzi; Gerald Gui Journal: Plast Reconstr Surg Glob Open Date: 2015-09-04