Momeni Arash
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center Palo Alto, Calif.
Plast Reconstr Surg Glob Open. 2018 Dec 17;6(12):e2046. doi: 10.1097/GOX.0000000000002046. eCollection 2018 Dec.
Implant-based breast reconstruction is the most common reconstructive modality in the United States. Significant advances in surgical technique and technology have resulted in improvement of clinical outcomes. A recent innovation has been the introduction of a tissue expander with an integral drain that permits access to the periprosthetic space. A new use for this drain port is presented in patients with postoperative surgical-site infection.
Patients who underwent staged implant-based breast reconstruction with the Sientra AlloX2 tissue expander and experienced postoperative infection that warranted inpatient management with intravenous antibiotics were included in the study. The integral drain port was used in these patients to perform washout of the periprosthetic space at the bedside. The ability to salvage the tissue expander in the setting of infection without the need for surgical revision in the operating room was determined.
Of 31 patients who underwent a total of 52 staged breast reconstructions with the Sientra AlloX2 tissue expander, 3 patients (8.7%) with a mean age of 50.3 years (range, 34-76 years) and mean body mass index of 23.3 kg/m (range, 22.3-24.1 kg/m) met inclusion criteria. Salvage of the device with successful progression through expansion and eventual expander-implant exchange was achieved in 2 patients. One patient failed the salvage attempt and required removal of the device.
Using the integral drain port of the AlloX2 tissue expander has the potential for device salvage in a subset of patients with surgical-site infection without the need for surgical revision.
在美国，植入式乳房重建是最常见的重建方式。手术技术和科技的重大进步已使临床结果得到改善。最近的一项创新是引入了一种带有一体式引流管的组织扩张器，该引流管可通向假体周围间隙。本文介绍了该引流口在术后手术部位感染患者中的一种新用途。
本研究纳入了接受Sientra AlloX2组织扩张器分期植入式乳房重建且术后感染需要住院静脉使用抗生素治疗的患者。在这些患者中，使用一体式引流口在床边对假体周围间隙进行冲洗。确定在感染情况下无需在手术室进行手术翻修即可挽救组织扩张器的可能性。
31例患者共接受了52次使用Sientra AlloX2组织扩张器的分期乳房重建，其中3例患者（8.7%）符合纳入标准，平均年龄50.3岁（范围34 - 76岁），平均体重指数23.3kg/m²（范围22.3 - 24.1kg/m²）。2例患者成功通过扩张并最终进行扩张器 - 植入物置换挽救了装置。1例患者挽救尝试失败，需要取出装置。
对于一部分手术部位感染的患者，使用AlloX2组织扩张器的一体式引流口有在无需手术翻修的情况下挽救装置的可能性。
