钛涂层聚丙烯网（TiLOOP Bra）在乳房重建中的应用：231 例多中心研究。
Implant-based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP Bra): a multicenter study of 231 cases.
机构信息
Rostock, Munich, Düsseldorf, Rheinfelden, and Berlin, Germany From the Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock; the Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, Technische Universität München, Roman Herzog Comprehensive Cancer Center; the Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Düsseldorf; Women's Clinic and Breast Center; the Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, Sankt Gertrauden Hospital; the Department of Senology, Vivantes Hospital; and the Department of Senology, Sana Hospital.
出版信息
Plast Reconstr Surg. 2013 Jul;132(1):8e-19e. doi: 10.1097/PRS.0b013e318290f8a0.
BACKGROUND
An alternative to implant-based breast reconstruction using acellular dermal matrix is the use of a titanium-coated polypropylene mesh. The mesh was approved for implant-based breast reconstruction in Europe in 2008, but only limited clinical data are available.
METHODS
Two hundred seven patients (231 breasts) with skin-sparing/nipple-sparing or modified radical mastectomy and immediate or delayed implant-based breast reconstruction using titanium-coated polypropylene mesh were evaluated retrospectively. The primary endpoints were identification of patient-related and surgical factors that were predictive for an adverse outcome and the development of recommendations for patients eligible for implant-based breast reconstruction using the mesh. Complications were divided into major (need for additional surgery), minor (conservative treatment), and implant loss. Univariate and multivariate logistic regression analyses were performed to determine the influence of the patient- and procedure-related characteristics on postoperative complications and implant loss.
RESULTS
No risk factors were observed for patient-associated complications. Major complications occurred in 13.4 percent, minor complications in 15.6 percent, and implant loss in 8.7 percent of patients. Univariate analysis revealed procedure-related risk factors for postoperative complications with a bilateral procedure (p = 0.013) or skin expansion before implant surgery (p = 0.043). Multivariate analysis confirmed these risk factors and revealed an increased risk for implant loss in patients with skin necrosis (p < 0.001) and capsule fibrosis (p < 0.001).
CONCLUSIONS
This titanium-coated polypropylene mesh shows acceptable complication rates and can be a helpful device in implant-based breast reconstruction. The mesh should only be used in primary cases and, when adhering to the proposed indications, is a safe and convenient option in implant-based breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
背景
使用脱细胞真皮基质进行基于植入物的乳房重建的替代方法是使用钛涂层聚丙烯网。该网于 2008 年在欧洲获得基于植入物的乳房重建的批准，但仅提供有限的临床数据。
方法
回顾性评估了 207 例（231 只乳房）接受保留皮肤/乳头或改良根治性乳房切除术并立即或延迟使用钛涂层聚丙烯网进行基于植入物的乳房重建的患者。主要终点是确定与患者相关的和手术相关的因素，这些因素可预测不良结果，并为有资格使用该网进行基于植入物的乳房重建的患者提出建议。并发症分为主要（需要额外手术）、次要（保守治疗）和植入物丢失。进行单变量和多变量逻辑回归分析，以确定与患者和手术相关的特征对术后并发症和植入物丢失的影响。
结果
未观察到与患者相关并发症的危险因素。13.4%的患者发生主要并发症，15.6%的患者发生次要并发症，8.7%的患者发生植入物丢失。单变量分析显示，双侧手术（p = 0.013）或植入术前皮肤扩张（p = 0.043）与术后并发症有关。多变量分析证实了这些危险因素，并显示皮肤坏死（p < 0.001）和包膜纤维化（p < 0.001）的患者发生植入物丢失的风险增加。
结论
这种钛涂层聚丙烯网显示出可接受的并发症发生率，并且可以成为基于植入物的乳房重建的有用装置。该网仅应在初次使用，并且在符合建议的适应症的情况下，在基于植入物的乳房重建中是一种安全方便的选择。
临床问题/证据水平：风险，III 级。
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