Besteht ein Unterschied zwischen DIEP- und freiem TRAM-Lappen aus physiologischer und psychologischer Sicht? Eine retrospektive Patientenbefragung

Translated title of the contribution: Is there a psychological and physiological difference between DIEP- and free TRAM-flap? A retrospective patient survey

P. Wurzer, S. Spendel, L. P. Kamolz, D. Parvizi, A. Tuca, T. Rappl

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The DIEP- (Deep Inferior Epigastric Perforator) flap and the free TRAM- (Transverser Rectus Abdominis Musculocutaneous) flap are common procedures for breast reconstruction. The aim of the study was to identify a difference in the psychological and physiological patient satisfaction between DIEP- and free TRAM-flap. Material and Methods: To provide a homogenous group, with a stable result of the reconstruction, the collective for questioning was picked out of the years 2009 and 2010. All patients included underwent a breast reconstruction with a DIEP-flap or free TRAM-flap at our division. For evaluation we formed 2 groups: DIEP-flap group (DLG) and TRAM-flap group (TLG). After preparing the questionnaire a telephone survey was performed. For the null hypothesis we postulated that there is no difference between DLG and TLG in the patient satisfaction. Results: We contacted 44 patients, 30 of them took part in our survey (15 from the DLG and 15 from the TLG). The mean BMI in the questionnaire group was 26.9kg/m and the mean age was 48.3 years. 2 questions (lifting heavy loads (p=0.005) and performing sit-up's (p=0.001)) show a significant difference between DLG and TLG, a benefit of the DLG could be seen. Both questions had the physiology of the rectus abdominis muscle as background. The complication rate for partial flap loss or partial necrosis was one third lower (p=0.299) in the TLG than compared to the DLG. Conclusion: Up to now, physicians think that the DIEP-flap seems to be the best possible procedure for breast reconstruction with belly flaps. However, numerous studies disprove the superiority in the donor site morbidity. In the literature, an advantage of the TRAM-flap is clearly visible by comparing the complication rates. Our oral interviewing also states that there is no difference in the psychological and physiological satisfaction of the patients. We can recommend a precise patient selection if a DIEP-flap for breast reconstruction should be performed. In case of comorbidities the possibility of the safer free TRAM-flap should be considered. In the future, a comparative analysis between the DIEP-flap, free TRAM-flap and pedicled TRAM-flap should be performed, by keeping the patients satisfaction, the complication rate and the cost effectiveness in mind.

Original languageGerman
Pages (from-to)256-262
Number of pages7
JournalHandchirurgie Mikrochirurgie Plastische Chirurgie
Volume46
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Rectus Abdominis
Myocutaneous Flap
Perforator Flap
Psychology
Mammaplasty
Patient Satisfaction
Surveys and Questionnaires
Telephone
Patient Selection
Cost-Benefit Analysis
Comorbidity
Necrosis
diclofenac hydroxyethylpyrrolidine
Tissue Donors
Morbidity
Physicians
Muscles

Keywords

  • breast
  • breast cancer
  • breast reconstruction
  • free flap plasty
  • tumour

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Besteht ein Unterschied zwischen DIEP- und freiem TRAM-Lappen aus physiologischer und psychologischer Sicht? Eine retrospektive Patientenbefragung. / Wurzer, P.; Spendel, S.; Kamolz, L. P.; Parvizi, D.; Tuca, A.; Rappl, T.

In: Handchirurgie Mikrochirurgie Plastische Chirurgie, Vol. 46, No. 4, 2014, p. 256-262.

Research output: Contribution to journalArticle

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abstract = "Background: The DIEP- (Deep Inferior Epigastric Perforator) flap and the free TRAM- (Transverser Rectus Abdominis Musculocutaneous) flap are common procedures for breast reconstruction. The aim of the study was to identify a difference in the psychological and physiological patient satisfaction between DIEP- and free TRAM-flap. Material and Methods: To provide a homogenous group, with a stable result of the reconstruction, the collective for questioning was picked out of the years 2009 and 2010. All patients included underwent a breast reconstruction with a DIEP-flap or free TRAM-flap at our division. For evaluation we formed 2 groups: DIEP-flap group (DLG) and TRAM-flap group (TLG). After preparing the questionnaire a telephone survey was performed. For the null hypothesis we postulated that there is no difference between DLG and TLG in the patient satisfaction. Results: We contacted 44 patients, 30 of them took part in our survey (15 from the DLG and 15 from the TLG). The mean BMI in the questionnaire group was 26.9kg/m and the mean age was 48.3 years. 2 questions (lifting heavy loads (p=0.005) and performing sit-up's (p=0.001)) show a significant difference between DLG and TLG, a benefit of the DLG could be seen. Both questions had the physiology of the rectus abdominis muscle as background. The complication rate for partial flap loss or partial necrosis was one third lower (p=0.299) in the TLG than compared to the DLG. Conclusion: Up to now, physicians think that the DIEP-flap seems to be the best possible procedure for breast reconstruction with belly flaps. However, numerous studies disprove the superiority in the donor site morbidity. In the literature, an advantage of the TRAM-flap is clearly visible by comparing the complication rates. Our oral interviewing also states that there is no difference in the psychological and physiological satisfaction of the patients. We can recommend a precise patient selection if a DIEP-flap for breast reconstruction should be performed. In case of comorbidities the possibility of the safer free TRAM-flap should be considered. In the future, a comparative analysis between the DIEP-flap, free TRAM-flap and pedicled TRAM-flap should be performed, by keeping the patients satisfaction, the complication rate and the cost effectiveness in mind.",
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AU - Kamolz, L. P.

AU - Parvizi, D.

AU - Tuca, A.

AU - Rappl, T.

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