Summary
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.
Keywords
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Article info
Publication history
Published online: July 30, 2012
Accepted:
July 2,
2012
Received:
January 5,
2012
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
