Long Chao, Sue Gloria R, Chattopadhyay Arhana, Huis In't Veld Eva, Lee Gordon K
Division of Plastic and Reconstructive Surgery, Stanford Health Care, Stanford, Calif.; and Stanford University School of Medicine, Stanford, Calif.
Plast Reconstr Surg Glob Open. 2017 Jul 5;5(7):e1386. doi: 10.1097/GOX.0000000000001386. eCollection 2017 Jul.
Infection is a dreaded complication following 2-stage implant-based breast reconstruction that can prolong the reconstructive process and lead to loss of implant. This study aimed to characterize outcomes of reconstructions complicated by infection, identify patient and surgical factors associated with infection, and use these to develop an infection management algorithm.
We performed a retrospective review of all consecutive implant-based breast reconstructions performed by the senior author (2006-2015) and collected data regarding patient demographics, medical history, operative variables, presence of other complications (necrosis, seroma, hematoma), and infection characteristics. Univariate and multivariate binomial logistic regression analyses were performed to identify independent predictors of infection.
We captured 292 patients who underwent 469 breast reconstructions. In total, 14.1% (n = 66) of breasts were complicated by infection, 87.9% (n = 58) of those were admitted and given intravenous antibiotics, 80.3% (n = 53) of all infections were cleared after the first attempt, whereas the remaining recurred at least once. The most common outcome was explantation (40.9%; n = 27), followed by secondary implant insertion (21.2%; n = 14) and operative salvage (18.2%; n = 12). Logistic regression analysis demonstrated that body mass index ( = 0.01), preoperative radiation ( = 0.02), necrosis ( < 0.001), seroma ( < 0.001), and hematoma ( = 0.03) were independent predictors of infection.
We observed an overall infectious complication rate of 14.1%. Heavier patients and patients who received preoperative radiation were more likely to develop infectious complications, suggesting that closer monitoring of high risk patients can potentially minimize infectious complications. Further, more aggressive management may be warranted for patients whose operations are complicated by necrosis, seroma, or hematoma.
感染是两阶段植入式乳房重建术后令人恐惧的并发症，它会延长重建过程并导致植入物丢失。本研究旨在描述感染并发症的重建结果，确定与感染相关的患者和手术因素，并据此制定感染管理算法。
我们对资深作者在2006年至2015年间进行的所有连续性植入式乳房重建进行了回顾性研究，并收集了患者人口统计学、病史、手术变量、其他并发症（坏死、血清肿、血肿）的存在情况以及感染特征等数据。进行单因素和多因素二项逻辑回归分析以确定感染的独立预测因素。
我们纳入了292例接受469次乳房重建的患者。总共有14.1%（n = 66）的乳房出现感染并发症，其中87.9%（n = 58）的患者入院并接受静脉抗生素治疗，所有感染中有80.3%（n = 53）在首次尝试后得以清除，而其余的至少复发一次。最常见的结果是取出植入物（40.9%；n = 27），其次是二次植入（21.2%；n = 14）和手术挽救（18.2%；n = 12）。逻辑回归分析表明，体重指数（P = 0.01）、术前放疗（P = 0.02）、坏死（P < 0.001）、血清肿（P < 0.001）和血肿（P = 0.03）是感染的独立预测因素。
我们观察到总体感染并发症发生率为14.1%。体重较重的患者和接受术前放疗的患者更易发生感染并发症，这表明对高危患者进行更密切的监测可能会潜在地减少感染并发症。此外，对于手术并发坏死、血清肿或血肿的患者，可能需要更积极的管理。
