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即刻植入物替换 DIEP 皮瓣：失败的基于植入物的乳房重建的单阶段挽救选择。

Immediate implant replacement with DIEP flap: a single-stage salvage option in failed implant-based breast reconstruction.

机构信息

Division of Plastic and Reconstructive Surgery, Mexican Institute of Social Security (IMSS), No. 21 Pino Suárez y 15 de Mayo, Av. Hidalgo 2480 pte, col. Obispado. C.p.64060. Cons. 212, Monterrey Nuevo León, Mexico.

Department of Plastic and Reconstructive Surgery, Hospital General Dr. Ruben Leñero, Plan de San Luis esq Salvador Díaz Mirón SN, Col. Santo Tomás. Deleg. Miguel Hidalgo. Cp. 11340. CDMX, Mexico City, Mexico.

出版信息

World J Surg Oncol. 2018 Apr 17;16(1):80. doi: 10.1186/s12957-018-1387-5.

DOI:10.1186/s12957-018-1387-5
PMID:29665804
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5905049/
Abstract

BACKGROUND

Implant-based immediate breast reconstruction after skin-sparing mastectomy has shown a significant improvement in patients' quality of life, making the procedure steadily more popular year after year. However, this technique has a high morbidity rate, including skin necrosis and implant exposure.

METHODS

A retrospective review of a prospectively held database for autologous breast reconstruction in our institution of the last 5 years found eight cases with exposed implants after nipple-sparing mastectomy and immediate reconstruction. A single-stage procedure consisting on implant removal and immediate replacement with a deepithelialized DIEP flap was performed in all cases (10 DIEP flaps).

RESULTS

All flaps were successful. Patients' mean age was 45 years old. Three patients developed seroma (5, 7, and 14 days after surgery, respectively). No infections were detected in up to 24 months of follow-up.

CONCLUSIONS

Nipple-sparing mastectomy with immediate implant-based reconstruction is considered oncologically safe. However, it has a high rate of complications that could require implant removal. Immediate free flap reconstruction is a feasible and safe option to replace the missing volume with low risk of complications that result in a soft and natural-shaped breast.

摘要

背景

保留皮肤的乳房切除术（skin-sparing mastectomy）后进行基于植入物的即刻乳房重建，已显著改善了患者的生活质量，使该手术在逐年稳步普及。然而，该技术具有较高的发病率，包括皮肤坏死和植入物外露。

方法

对我院过去 5 年自体乳房重建的前瞻性数据库进行回顾性分析，发现 8 例接受保留乳头的乳房切除术和即刻重建后发生植入物外露的病例。所有病例均采用单阶段手术，包括植入物取出和即刻用去上皮化的 DIEP 皮瓣进行修复（共 10 个 DIEP 皮瓣）。

结果

所有皮瓣均成功。患者的平均年龄为 45 岁。3 例患者发生血清肿（分别于术后第 5、7 和 14 天）。在长达 24 个月的随访中，未发现感染。

结论

保留乳头的乳房切除术即刻进行基于植入物的重建被认为在肿瘤学上是安全的。然而，其并发症发生率较高，可能需要取出植入物。即刻游离皮瓣重建是一种可行且安全的选择，可以用低并发症风险替换缺失的体积，从而获得柔软自然的乳房形状。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/5d0f3bf13ea8/12957_2018_1387_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/4c10b5ded8df/12957_2018_1387_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/00118253ed9f/12957_2018_1387_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/1ecc739d3d11/12957_2018_1387_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/09d747ba1333/12957_2018_1387_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/58a5aa62cdd1/12957_2018_1387_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/5d0f3bf13ea8/12957_2018_1387_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/4c10b5ded8df/12957_2018_1387_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/00118253ed9f/12957_2018_1387_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/1ecc739d3d11/12957_2018_1387_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/09d747ba1333/12957_2018_1387_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/58a5aa62cdd1/12957_2018_1387_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe2/5905049/5d0f3bf13ea8/12957_2018_1387_Fig6_HTML.jpg

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