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Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps

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Author(s)
Woonhyeok JeongSeongwon LeeJunhyung Kim
Keimyung Author(s)
Kim, Jun Hyung
Department
Dept. of Plastic Surgery (성형외과학)
Journal Title
Breast
Issued Date
2018
Volume
38
Keyword
ComplicationsDIEP flapFree TRAM flapMeta-analysisPedicled TRAM flap
Abstract
OBJECTIVES:
The transverse rectus abdominis musculocutaneous (TRAM) flap is an important option for breast reconstruction. Several studies have recently evaluated whether a greater number of complications result from the use of pedicled TRAM (pTRAM) flaps versus either free TRAM (fTRAM) flaps or deep inferior epigastric artery perforator (DIEP) flaps. To clarify the evidence regarding this issue, we performed an objective meta-analysis of published studies.

MATERIALS AND METHODS:
A literature search of articles published between January 1, 1990, to January 1, 2017 was performed using the PubMed, EMBASE, Scopus, and Cochrane databases. Heterogeneity was statistically analyzed, and fixed effects and random effects models were used as appropriate.

RESULTS:
Eleven articles comparing pedicled TRAM (pTRAM) flaps with either free TRAM (fTRAM) or DIEP flaps were included. The articles evaluated a total of 3968 flaps, including 1891 pTRAM flaps, 866 fTRAM flaps, and 1211 DIEP flaps. Patients with fTRAM flaps had a significantly lower risk of fat necrosis and partial flap necrosis than those with pTRAM flaps. No difference was observed in total flap necrosis and hernia or bulge between fTRAM and pTRAM flaps. No difference was noted in flap complications between DIEP and pTRAM flaps except for hernia or bulge..

CONCLUSION:
Although pTRAM flaps are being replaced by fTRAM and DIEP flaps, which exhibit fewer complications related to flap ischemia and donor site morbidity, it was unclear from the literature which flap type was most beneficial regarding flap vascularity and donor site morbidity. Hence, surgeons should choose the appropriate option based on their preferences and on patient factors..
Keimyung Author(s)(Kor)
김준형
Publisher
School of Medicine (의과대학)
Citation
Woonhyeok Jeong et al. (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
Type
Article
ISSN
0960-9776
Source
https://linkinghub.elsevier.com/retrieve/pii/S0960-9776(17)30785-3
DOI
10.1016/j.breast.2017.12.003
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41348
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Plastic Surgery (성형외과학)
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