Complications After Breast Reconstruction With Pedicled And Free Transverse Rectus Abdominis Musculocutaneous Flap:A Meta-analysis

Objective The complication rates of breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap and free transverse rectus abdominis myocutaneous flap were compared.In order to provide the basis for clinicians in the operation decision.Methods The randomized controlled studies on breast reconstruction with pedicled and free transverse rectus abdominis myocutaneous flap were searched in Chinese and English databases such as CNKI,Wanfang,VIP,Cochrane Library and Pub Med from the database establishment to January 2021 Statistical analysis was performed by stata15.0software,and heterogeneity was evaluated by Q-test and I2 test.When heterogeneity existed,the source of heterogeneity was found by subgroup analysis,and RR and 95% CI were calculated by random effect model.Otherwise,fixed effect model was used.The outcome indexes were fat necrosis,local necrosis of skin flap,complete necrosis of skin flap,seroma,postoperative wound infection and abdominal wall hernia.Results Fourteen case-control studies were selected finally.There were 3331 patients in total including 1924 receiving PTRAM surgery and 1407 undergoing FTRAM surgery.Reconstructive surgeries were performed in 2014 and 1,436,respectively.The results of Meta-analysis showed that the incidence of fat necrosis in the FTRAM group was lower than that in the PTRAM group and there was a significant difference(RR: 1.66,95% CI: 1.36,2.03).The incidence of local flap necrosis in the FTRAM group was lower than that in the PTRAM group and there was a significant difference(RR: 1.59,95% CI: 1.15,2.21).The incidence of seroma in the FTRAM group was lower than that in the PTRAM group and there was a significant difference(RR: 1.55,95% CI: 1.10,2.17).The incidence of complete necrosis of the two surgical flaps was similar,and there was no significant difference(RR:0.73,95% CI: 0.37,1.45).There was no statistically significant difference in the incidence of postoperative wound infection(RR: 1.10,95% CI: 0.74,1.66).The incidence of abdominal wall hernia in the PTRAM group was higher than that in the FTRAM group and there was a significant difference(RR: 1.59,95%CI: 1.06,2.39).Conclusion Compared with PTRAM breast reconstruction,the incidence of skin flap necrosis and postoperative wound infection was similar,and the difference was not statistically significant.The incidence of skin flap necrosis,seroma,abdominal wall hernia,and fat necrosis after PTRAM breast reconstruction was significantly higher than that of FTRAM,and the difference was statistically significant.In terms of complications,free transverse rectus abdominis musculocutaneous flap breast reconstruction is better than pedicled transverse rectus abdominis musculocutaneous flap breast reconstruction.However,due to the limitation of the quality and quantity of the included literature,the results still need to be interpreted carefully,and higher quality literature or research needs to be further included to provide a more reliable theoretical basis for the reasonable choice of autologous breast reconstruction.