Song Joon Ho, Kim Young Seok, Jung Bok Ki, Lee Dong Won, Song Seung Yong, Roh Tai Suk, Lew Dae Hyun
Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Gangnam Severance Hospital, Seoul, Korea.
Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Arch Plast Surg. 2017 Nov;44(6):516-522. doi: 10.5999/aps.2017.01025. Epub 2017 Oct 27.
Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure.
We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Age, body mass index, chemotherapy history, radiation exposure, and smoking history were assessed as potential risk factors for postoperative infection. We also evaluated the presence and onset of infection symptoms, wound culture pathogens, and other complications, including seroma, hematoma, and mastectomy skin necrosis. Additionally, we examined the mastectomy type, the use of acellular dermal matrix, the presence of an underlying disease such as hypertension or diabetes, and axillary node dissection.
The total infection rate was 4.99% (58 of 1,163 cases) and the total salvage rate was 58.6% (34 of 58). The postoperative duration to closed suction drain removal was significantly different between the cellulitis and implant removal groups. Staphylococcus aureus infection was most frequently found, with methicillin resistance in 37.5% of the cases of explantation. Explantation after infection was performed more often in patients who had undergone 2-stage expander/implant reconstruction than in those who had undergone direct-to-implant reconstruction.
Preventing infection is essential in implant-based breast reconstruction. The high salvage rate argues against early implant removal. However, when infection is due to methicillin-resistant S. aureus and the patient's clinical symptoms do not improve, surgeons should consider implant removal.
基于植入物的乳房重建手术越来越频繁，而植入物与感染风险增加有关。我们回顾了植入物感染病例的临床特征，并调查了乳房装置挽救失败的危险因素。
我们回顾性分析了2010年1月至2016年12月期间接受基于植入物的乳房重建手术的771例患者。评估年龄、体重指数、化疗史、放疗史和吸烟史作为术后感染的潜在危险因素。我们还评估了感染症状的存在和发作、伤口培养病原体以及其他并发症，包括血清肿、血肿和乳房切除术后皮肤坏死。此外，我们检查了乳房切除术类型、无细胞真皮基质的使用、是否存在如高血压或糖尿病等基础疾病以及腋窝淋巴结清扫情况。
总感染率为4.99%（1163例中的58例），总挽救率为58.6%（58例中的34例）。蜂窝织炎组和植入物取出组之间，闭合式负压引流管拔除后的术后持续时间有显著差异。最常发现金黄色葡萄球菌感染，在37.5%的取出植入物病例中存在耐甲氧西林情况。与直接植入式重建患者相比，接受两阶段扩张器/植入物重建的患者在感染后更常进行植入物取出。
在基于植入物的乳房重建中预防感染至关重要。高挽救率表明反对早期取出植入物。然而，当感染是由耐甲氧西林金黄色葡萄球菌引起且患者的临床症状没有改善时，外科医生应考虑取出植入物。
