Winocour Sebastian, Saksena Anshuman, Oh Christine, Wu Peter S, Laungani Alexis, Baltzer Heather, Saint-Cyr Michel
Rochester, Minn. From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic.
Plast Reconstr Surg. 2016 Jan;137(1):14e-23e. doi: 10.1097/PRS.0000000000001861.
Many techniques have been described for nipple reconstruction, with the principal limitation being excessive loss of projection. The ideal reconstructed nipple provides sustained projection, the fewest complications, and high levels of patient satisfaction. A variety of materials are available for projection augmentation, including autologous, allogeneic, and synthetic materials. To date, there has been no systematic review to study the efficacy, projection, and complication rates of different materials used in nipple reconstruction.
MEDLINE, Embase, and PubMed databases were searched, from inception to August of 2014, to identify literature reporting on outcomes of autologous, allogeneic, and synthetic grafts in nipple reconstruction. Retrospective and prospective studies with controlled and uncontrolled conditions were included. Studies reporting the use of autologous flap techniques without grafts and articles lacking postoperative outcomes were excluded. Study quality was assessed using the Newcastle-Ottawa Scale.
Thirty-one studies met the inclusion criteria. After evidence review, one study represented two of nine stars on the Newcastle-Ottawa Scale, two studies represented three stars, six studies represented four stars, seven studies represented five stars, 11 studies represented six stars, and four studies represented seven stars.
The results of this review revealed heterogeneity in the type of material used within each category and inconsistent methodology used in outcomes assessment in nipple reconstruction. Overall, the quality of evidence is low. Synthetic materials have higher complication rates and allogeneic grafts have nipple projection comparable to that of autologous grafts. Further investigation with high-level evidence is necessary to determine the optimal material for nipple reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
乳头重建已有多种技术被描述，主要局限性是突出度过度丧失。理想的重建乳头应具备持久的突出度、最少的并发症以及较高的患者满意度。有多种材料可用于增加突出度，包括自体材料、同种异体材料和合成材料。迄今为止，尚无系统评价来研究乳头重建中使用的不同材料的疗效、突出度和并发症发生率。
检索MEDLINE、Embase和PubMed数据库，检索时间从建库至2014年8月，以识别关于自体、同种异体和合成移植物在乳头重建中结果的文献报道。纳入有对照和无对照条件的回顾性和前瞻性研究。排除报告使用无移植物的自体皮瓣技术的研究以及缺乏术后结果的文章。使用纽卡斯尔-渥太华量表评估研究质量。
31项研究符合纳入标准。证据审查后，一项研究在纽卡斯尔-渥太华量表上得两颗星（满分九星），两项研究得三颗星，六项研究得四颗星，七项研究得五颗星，11项研究得六颗星，四项研究得七颗星。
本综述结果显示，乳头重建中各类材料的使用类型存在异质性，结果评估所采用的方法也不一致。总体而言，证据质量较低。合成材料的并发症发生率较高，同种异体移植物的乳头突出度与自体移植物相当。需要进一步开展高质量证据的研究，以确定乳头重建的最佳材料。
临床问题/证据级别：治疗性，IV级。
