Valdatta Luigi, Cattaneo Anna Giulia, Pellegatta Igor, Scamoni Stefano, Minuti Anna, Cherubino Mario
Department of Biotechnology & Life Science (DBSV), University of Insubria, 21100 Varese, Italy ; Plastic and Reconstructive Surgery Division, Ospedale di Circolo di Varese, Viale Borri 57, 21100 Varese, Italy.
Department of Biotechnology & Life Science (DBSV), University of Insubria, 21100 Varese, Italy.
Plast Surg Int. 2014;2014:472604. doi: 10.1155/2014/472604. Epub 2014 May 21.
The increasing use of commercially available acellular dermis matrices for postmastectomy breast reconstruction seems to have simplified the surgical procedure and enhanced the outcome. These materials, generally considered to be highly safe or with only minor contraindications due to the necessary manipulation in preparatory phases, allow an easier one-phase surgical procedure, in comparison with autologous flaps, offering a high patient satisfaction. Unfortunately, the claim for a higher rate of complications associated with irradiation at the implant site, especially when the radiation therapy was given before the reconstructive surgery, suggested a careful behaviour when this technique is preferred. However, this hypothesis was never submitted to a crucial test, and data supporting it are often discordant or incomplete. To provide a comprehensive analysis of the field, we searched and systematically reviewed papers published after year 2005 and registered clinical trials. On the basis of a meta-analysis of data, we conclude that the negative effect of the radiotherapy on the breast reconstruction seems to be evident even in the case of acellular dermis matrices aided surgery. However, more trials are needed to make solid conclusions and clarify the poor comprehension of all the factors negatively influencing outcome.
在乳房切除术后乳房重建中，越来越多地使用市售脱细胞真皮基质似乎简化了手术过程并改善了结果。这些材料通常被认为高度安全，或因制备阶段的必要操作仅有轻微禁忌证，与自体皮瓣相比，可使手术更易于一期完成，患者满意度较高。不幸的是，有观点认为植入部位放疗相关并发症发生率较高，尤其是在重建手术前进行放疗时，这表明在选择该技术时需谨慎。然而，这一假设从未经过关键测试，支持该假设的数据往往不一致或不完整。为了对该领域进行全面分析，我们检索并系统回顾了2005年后发表的论文及注册的临床试验。基于数据的荟萃分析，我们得出结论，即使在脱细胞真皮基质辅助手术的情况下，放疗对乳房重建的负面影响似乎也很明显。然而，需要更多试验才能得出确凿结论，并澄清对所有负面影响结果的因素的理解不足。
