Complicações dos Métodos DIEP e TRAM na reconstrução mamária
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Publicado
Apr 15, 2023
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Resumo
Objetivo: Analisar e esclarecer as principais complicações dos métodos Retalho do Músculo Reto Abdominal (TRAM) e Retalho de perfurante da Artéria Epigástrica inferior (DIEP) na reconstrução mamária em pacientes após tratamento de câncer de mama. Métodos: Para realização do trabalho foram feitas duas etapas utilizando as bases National Library of Medicine (PubMed) e a Portal Regional da Biblioteca Virtual em Saúde (PR-BVS), com os descritores “Breast reconstruction”, “DIEP Flap”, “Complications” para a primeira etapa e “Breast reconstruction”, “TRAM” e “Complications” para a segunda etapa. Foram incluídos artigos com texto completo, em inglês, do tipo ensaio clínico e ensaio clínico randomizado e excluídos aqueles que estavam duplicados ou fugiram do tema. Resultados: Através dos estudos analisados foram encontradas complicações mais incidentes quando somados a fatores de risco, dentre elas a necrose tecidual e hérnias incisionais e algumas menos incidentes, mas com maior severidade como a embolia pulmonar e trombose venosa profunda. Considerações Finais: Observa-se que para que as complicações sejam minimizadas ou evitadas o médico deve ter uma boa técnica operatória e fazer um bom acompanhamento pré e pós-operatório.
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Como Citar
BrittesC. F. T., & MaiaL. M. de O. (2023). Complicações dos Métodos DIEP e TRAM na reconstrução mamária. Revista Eletrônica Acervo Saúde, 23(4), e11938. https://doi.org/10.25248/reas.e11938.2023
Seção
Revisão Bibliográfica
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Referências
1. ANDREE C, et al. A single center prospective study of bilateral breast reconstruction with free abdominal flaps: a critical analyses of 144 patients. Medical science monitor: international medical journal of experimental and clinical research, 2013; 17(19): 467-74.
2. ANDREE C, et al. Improved safety of autologous breast reconstruction surgery by stabilisation of microsurgical vessel anastomoses using fibrin sealant in 349 free DIEP or fascia-muscle-sparing (fms)-TRAM flaps: a two-centre study. Breast (Edinburgh, Scotland), 2008; 17(5): 492–8.
3. AHMAD FI, et al. The role of postoperative hematoma on free flap compromise. The Laryngoscope, 2015; 125(8): 1811–5.
4. BERTOZZI N, et al. Oncoplastic breast surgery: comprehensive review. European review for medical and pharmacological sciences, 2017; 21(11): 2572-85.
5. BEUGELS J, et al. Complications in unilateral versus bilateral deep inferior epigastric artery perforator flap breast reconstructions: A multicentre study. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 2016; 69(9): 1291–8.
6. BLONDEEL N, et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. British journal of plastic surgery, 1997; 50(5): 322–30.
7. BRASIL. Ministério da Saúde (BR), Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Atlas On-line de mortalidade por câncer – tabulador; 2014. Disponível em: https://www.inca.gov.br/app/mortalidade. Acessado em: 1 de maio de 2022.
8. BRORSON F, et al. Early complications in delayed breast reconstruction: A prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2020; 46(12): 2208–17.
9. BROWNE JP, et al. The association between complications and quality of life after mastectomy and breast reconstruction for breast cancer. Cancer, 2017; 123(18): 3460-7.
10. BRUNBJERG ME, et al. Reinforcement of the abdominal wall with acellular dermal matrix or synthetic mesh after breast reconstruction with the pedicled transverse rectus abdominis musculocutaneous flap. A prospective double-blind randomized study. Journal of plastic surgery and hand surgery, 2021; 55(4): 202-209.
11. CUNHA MS, et al. Avaliação da Perfusão do Retalho de Perfurante da Artéria Epigástrica Inferior Microcirúrgico Aplicado em Reconstrução Mamária. Revista Brasileira de Cirurgia Plástica, 2006; 21(4): 191-5.
12. DAUPLAT J, et al. Risk Factors Associated With Complications After Unilateral Immediate Breast Reconstruction: A French Prospective Multicenter Study. In vivo, 2021; 35 (2):937–45.
13. GART MS, et al. Autologous options for postmastectomy breast reconstruction: a comparison of outcomes based on the American College of Surgeons National Surgical Quality Improvement Program. Journal of the American College of Surgeons, 2013; 216(2): 229–38.
14. HESTAK KC, et al. Treatment of difficult TRAM flap hernias using intraperitoneal synthetic mesh application. Plastic and reconstructive surgery, 2001; 107(1): 55–62.
15. IVERSON RE e GOMEZ JL. Deep venous thrombosis: Prevention and Management. Clinics in Plastic Surgery, 2013; 40(3): 389–98.
16. KAYA B e SEREL S. Breast reconstruction. Experimental Oncology. 2013; 35(4): 280-6.
17. KELLER A. The deep inferior epigastric perforator free flap for breast reconstruction. Annals of Plastic Surgery, 2001; 46(5): 474–80.
18. KIM EK, et al. Immediate transverse rectus abdominis musculocutaneous (Tram) flap breast reconstruction in underweight Asian patients. Breast Cancer, 2014; 21(6): 693–7.
19. KLASSON S, et al. Preoperative CT angiography versus Doppler ultrasound mapping of abdominal perforator in DIEP breast reconstructions: A randomized prospective study. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 2015; 68(6): 782–6.
20. KONOEDA H, et al. Incidence of deep vein thrombosis in patients undergoing breast reconstruction with autologous tissue transfer. Phlebology, 2017; 32(4): 282–8.
21. MATOS SEM, et al. Análise epidemiológica do câncer de mama no Brasil: 2015 a 2020 / Epidemiological analysis of breast cancer in Brazil: 2015 to 2020. Brazilian Journal of Health Review, 2021; 4(3): 13320–30.
22. MACEDO YD, et al. Mulheres mastectomizadas: fatores excludentes da reconstrução mamária. Enfermagem em Foco, 2021; 12(1): 61-6.
23. McCARTHY C, et al. Use of abdominal quilting sutures for seroma prevention in tram flap reconstruction: a prospective, controlled trial. Annals of Plastic Surgery, 2005; 54(4): 361–4.
24. MORAN SL, et al. An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients. Plastic and Reconstructive Surgery, 2003; 111(6): 1876–82.
25. MULLER-SLOOF E, et al. The effect of postoperative closed incision negative pressure therapy on the incidence of donor site wound dehiscence in breast reconstruction patients: DEhiscence PREvention Study (DEPRES), pilot randomized controlled trial. Journal of tissue viability, 2018; 27(4): 262–6.
26. NELSON JA, et al. Wound healing complications after autologous breast reconstruction: A model to predict risk. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 2015; 68(4): 531–9.
27. PINELL-WHITE XA, et al. The management of abdominal contour defects following tram flap breast reconstruction. Aesthetetic Surgery Journal, 2014; 34(2): 264–71.
28. PHAN R, et al. Risk factors and timing of postoperative hematomas following microvascular breast reconstruction: A prospective cohort study. Microsurgery, 2020; 40(2): 99–103.
29. QIU D, et al. Risk factors for necrosis of skin flap-like wounds after ED debridement and suture. The American journal of emergency medicine, 2019; 37(5): 828–31.
30. RAO A e SAADEH PB. Defining fat necrosis in plastic surgery. Plastic and reconstructive surgery, 2014; 134(6): 1202–12.
31. SANTOSA KB, et al. Contralateral prophylactic mastectomy and implications for breast reconstruction. Gland Surgery, 2021; 10(1): 498-506.
32. SHAFIGHI M, et al. The extended diep flap: Extending the possibilities for breast reconstruction with tissue from the lower abdomen. Microsurgery, 2013; 33(1): 24–31.
33. SHULTZ KJ, et al. Pulmonary Function After Pedicled Transverse Rectus Abdominis Musculocutaneous Flap Breast Reconstruction. Annals of Plastic Surgery, 2016; 77(1): 106-9.
34. SUOMINEN S, et al. Sequelae in the abdominal wall after pedicled or free TRAM flap surgery. Annals of Plastic Surgery, 1996; 36(6): 629-36.
35. TALLROTH L, et al. A short-term comparison of expander prosthesis and DIEP flap in breast reconstructions: A prospective randomized study. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 2021; 74(6): 1193–202.
36. TAMURA R, et al. “Skin necrosis.” Advances in oto-rhino-laryngology, 2014; 75: 103-5.
37. TSOUTSOS D, et al. Upper cervicothoracic sympathetic block increases blood supply of unipedicled TRAM flap. Annals of Plastic Surgery, 2008; 61(3): 247-51.
38. ULATOWSKI Ł e KANIEWSKA A. The use of the diep flap in the modern reconstructive surgery. Polski przeglad chirurgiczny, 2015; 87(9): 472-81.
39. VARELA R, et al. Outcomes of diep flap and fluorescent angiography: a randomized controlled clinical trial. Plastic and reconstructive surgery, 2020; 145(1): 1–10.
40. WILLIAMS JK, et al. TRAM flap breast reconstruction after radiation treatment. Annals of Surgery, 1995; 221(6): 756-64-764-6.
2. ANDREE C, et al. Improved safety of autologous breast reconstruction surgery by stabilisation of microsurgical vessel anastomoses using fibrin sealant in 349 free DIEP or fascia-muscle-sparing (fms)-TRAM flaps: a two-centre study. Breast (Edinburgh, Scotland), 2008; 17(5): 492–8.
3. AHMAD FI, et al. The role of postoperative hematoma on free flap compromise. The Laryngoscope, 2015; 125(8): 1811–5.
4. BERTOZZI N, et al. Oncoplastic breast surgery: comprehensive review. European review for medical and pharmacological sciences, 2017; 21(11): 2572-85.
5. BEUGELS J, et al. Complications in unilateral versus bilateral deep inferior epigastric artery perforator flap breast reconstructions: A multicentre study. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 2016; 69(9): 1291–8.
6. BLONDEEL N, et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. British journal of plastic surgery, 1997; 50(5): 322–30.
7. BRASIL. Ministério da Saúde (BR), Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Atlas On-line de mortalidade por câncer – tabulador; 2014. Disponível em: https://www.inca.gov.br/app/mortalidade. Acessado em: 1 de maio de 2022.
8. BRORSON F, et al. Early complications in delayed breast reconstruction: A prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2020; 46(12): 2208–17.
9. BROWNE JP, et al. The association between complications and quality of life after mastectomy and breast reconstruction for breast cancer. Cancer, 2017; 123(18): 3460-7.
10. BRUNBJERG ME, et al. Reinforcement of the abdominal wall with acellular dermal matrix or synthetic mesh after breast reconstruction with the pedicled transverse rectus abdominis musculocutaneous flap. A prospective double-blind randomized study. Journal of plastic surgery and hand surgery, 2021; 55(4): 202-209.
11. CUNHA MS, et al. Avaliação da Perfusão do Retalho de Perfurante da Artéria Epigástrica Inferior Microcirúrgico Aplicado em Reconstrução Mamária. Revista Brasileira de Cirurgia Plástica, 2006; 21(4): 191-5.
12. DAUPLAT J, et al. Risk Factors Associated With Complications After Unilateral Immediate Breast Reconstruction: A French Prospective Multicenter Study. In vivo, 2021; 35 (2):937–45.
13. GART MS, et al. Autologous options for postmastectomy breast reconstruction: a comparison of outcomes based on the American College of Surgeons National Surgical Quality Improvement Program. Journal of the American College of Surgeons, 2013; 216(2): 229–38.
14. HESTAK KC, et al. Treatment of difficult TRAM flap hernias using intraperitoneal synthetic mesh application. Plastic and reconstructive surgery, 2001; 107(1): 55–62.
15. IVERSON RE e GOMEZ JL. Deep venous thrombosis: Prevention and Management. Clinics in Plastic Surgery, 2013; 40(3): 389–98.
16. KAYA B e SEREL S. Breast reconstruction. Experimental Oncology. 2013; 35(4): 280-6.
17. KELLER A. The deep inferior epigastric perforator free flap for breast reconstruction. Annals of Plastic Surgery, 2001; 46(5): 474–80.
18. KIM EK, et al. Immediate transverse rectus abdominis musculocutaneous (Tram) flap breast reconstruction in underweight Asian patients. Breast Cancer, 2014; 21(6): 693–7.
19. KLASSON S, et al. Preoperative CT angiography versus Doppler ultrasound mapping of abdominal perforator in DIEP breast reconstructions: A randomized prospective study. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 2015; 68(6): 782–6.
20. KONOEDA H, et al. Incidence of deep vein thrombosis in patients undergoing breast reconstruction with autologous tissue transfer. Phlebology, 2017; 32(4): 282–8.
21. MATOS SEM, et al. Análise epidemiológica do câncer de mama no Brasil: 2015 a 2020 / Epidemiological analysis of breast cancer in Brazil: 2015 to 2020. Brazilian Journal of Health Review, 2021; 4(3): 13320–30.
22. MACEDO YD, et al. Mulheres mastectomizadas: fatores excludentes da reconstrução mamária. Enfermagem em Foco, 2021; 12(1): 61-6.
23. McCARTHY C, et al. Use of abdominal quilting sutures for seroma prevention in tram flap reconstruction: a prospective, controlled trial. Annals of Plastic Surgery, 2005; 54(4): 361–4.
24. MORAN SL, et al. An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients. Plastic and Reconstructive Surgery, 2003; 111(6): 1876–82.
25. MULLER-SLOOF E, et al. The effect of postoperative closed incision negative pressure therapy on the incidence of donor site wound dehiscence in breast reconstruction patients: DEhiscence PREvention Study (DEPRES), pilot randomized controlled trial. Journal of tissue viability, 2018; 27(4): 262–6.
26. NELSON JA, et al. Wound healing complications after autologous breast reconstruction: A model to predict risk. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 2015; 68(4): 531–9.
27. PINELL-WHITE XA, et al. The management of abdominal contour defects following tram flap breast reconstruction. Aesthetetic Surgery Journal, 2014; 34(2): 264–71.
28. PHAN R, et al. Risk factors and timing of postoperative hematomas following microvascular breast reconstruction: A prospective cohort study. Microsurgery, 2020; 40(2): 99–103.
29. QIU D, et al. Risk factors for necrosis of skin flap-like wounds after ED debridement and suture. The American journal of emergency medicine, 2019; 37(5): 828–31.
30. RAO A e SAADEH PB. Defining fat necrosis in plastic surgery. Plastic and reconstructive surgery, 2014; 134(6): 1202–12.
31. SANTOSA KB, et al. Contralateral prophylactic mastectomy and implications for breast reconstruction. Gland Surgery, 2021; 10(1): 498-506.
32. SHAFIGHI M, et al. The extended diep flap: Extending the possibilities for breast reconstruction with tissue from the lower abdomen. Microsurgery, 2013; 33(1): 24–31.
33. SHULTZ KJ, et al. Pulmonary Function After Pedicled Transverse Rectus Abdominis Musculocutaneous Flap Breast Reconstruction. Annals of Plastic Surgery, 2016; 77(1): 106-9.
34. SUOMINEN S, et al. Sequelae in the abdominal wall after pedicled or free TRAM flap surgery. Annals of Plastic Surgery, 1996; 36(6): 629-36.
35. TALLROTH L, et al. A short-term comparison of expander prosthesis and DIEP flap in breast reconstructions: A prospective randomized study. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 2021; 74(6): 1193–202.
36. TAMURA R, et al. “Skin necrosis.” Advances in oto-rhino-laryngology, 2014; 75: 103-5.
37. TSOUTSOS D, et al. Upper cervicothoracic sympathetic block increases blood supply of unipedicled TRAM flap. Annals of Plastic Surgery, 2008; 61(3): 247-51.
38. ULATOWSKI Ł e KANIEWSKA A. The use of the diep flap in the modern reconstructive surgery. Polski przeglad chirurgiczny, 2015; 87(9): 472-81.
39. VARELA R, et al. Outcomes of diep flap and fluorescent angiography: a randomized controlled clinical trial. Plastic and reconstructive surgery, 2020; 145(1): 1–10.
40. WILLIAMS JK, et al. TRAM flap breast reconstruction after radiation treatment. Annals of Surgery, 1995; 221(6): 756-64-764-6.