Tampa, Fla. From the Division of Plastic Surgery, Department of Surgery, and the Division of Infectious Diseases and Internal Medicine, University of South Florida.
Plast Reconstr Surg. 2012 Jan;129(1):42-48. doi: 10.1097/PRS.0b013e3182361fbd.
Breast prosthesis reconstruction continues to be the most common form of breast reconstruction, and infection and exposure remain major concerns for patients and surgeons.
A retrospective review was performed of patients who underwent attempted implant salvage between 2002 and 2008 by a single surgeon according to a single protocol. Analyzed data include detailed patient demographics, clinical and laboratory findings, and outcomes.
Sixty patients were identified who had been taken to the operating room secondary to infection and/or exposure of a breast prosthesis. Seventeen underwent removal of the prosthesis without attempted salvage and 43 patients underwent attempted salvage. Successful attempted salvage occurred in 76.7 percent of cases, with a mean follow-up of 18.4 months (range, 1 to 60 months). Staphylococcus epidermidis led to a statistically higher rate of failed salvage (25 percent versus 0 percent, p = 0.04). Of the 33 patients who had successful salvage of the prosthesis, two developed capsular contracture (6 percent).
Intervention should be prompt and aggressive, and should implement a combination of surgical and antimicrobial therapies. The data from the authors' results provide additional tools for patient selection and treatment, and offer a simplified management protocol for breast reconstruction patients with infected and/or exposed breast prostheses.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
乳房假体重建仍然是最常见的乳房重建形式，感染和外露仍然是患者和外科医生关注的主要问题。
对 2002 年至 2008 年间，由一名外科医生根据单一方案对试图进行植入物挽救的患者进行了回顾性分析。分析的数据包括详细的患者人口统计学，临床和实验室检查结果以及结果。
确定了 60 名因乳房假体感染和/或外露而被送入手术室的患者。17 名患者未进行尝试挽救而直接去除了假体，而 43 名患者则进行了尝试挽救。在 76.7％的病例中成功进行了尝试挽救，平均随访时间为 18.4 个月（范围为 1 至 60 个月）。表皮葡萄球菌导致挽救成功率明显降低（25％对 0％，p = 0.04）。在成功挽救假体的 33 名患者中，有 2 名患者发生了包膜挛缩（6％）。
干预措施应迅速而积极，并应实施手术和抗菌疗法的组合。作者的研究结果提供了更多的患者选择和治疗工具，并为患有感染和/或外露乳房假体的乳房重建患者提供了简化的管理方案。
临床问题/证据水平：治疗，IV。
