From the Plastic and Reconstructive Surgery Department, University of Montreal Hospital Center; the University of Sherbrooke; and the University of Montreal.
Plast Reconstr Surg. 2019 Dec;144(6):988e-992e. doi: 10.1097/PRS.0000000000006227.
Acellular dermal matrices have become a mandatory tool in reconstructive breast surgery. Since their introduction, they have been considered to be nonreactive and nonimmunogenic scaffolds. However, some patients who undergo implant-based breast reconstruction with acellular dermal matrices develop postoperative cutaneous erythema overlying their matrices, a condition commonly referred to as red breast syndrome. The aim of this study was to gain a better understanding of this phenomenon. An analysis was conducted on consecutive patients who underwent acellular dermal matrix- and implant-based breast reconstructions and developed red breast syndrome that was treated surgically between April of 2017 and June of 2018 at the authors' institution. During surgery, 1-cm specimens of acellular dermal matrix were sampled and analyzed by scanning electron microscopy. Observations were charted to score and record the presence and thickness of biofilm, and for identification of bacteria. These measurements were performed using Adobe Photoshop CS6 Extended software. Six postmastectomy breast reconstruction patients were included, all with AlloDerm Ready-to-Use-based reconstructions. All specimens were colonized by various bacteria ranging from Gram-negative bacilli to Gram-positive microorganisms. Biofilm was present in all studied specimens. The cause of skin erythema overlying acellular dermal matrix grafts, and the so-called red breast syndrome, may be related to contamination with various bacteria. Although contamination was omnipresent in analyzed samples, its clinical significance is variable. Even if acellular dermal matrix-based reconstructions are salvaged, this could come at the price of chronic local inflammation.
脱细胞真皮基质已成为重建乳房手术中的必备工具。自引入以来，它们一直被认为是无反应性和非免疫原性的支架。然而，一些接受脱细胞真皮基质植入物乳房重建的患者在其基质上出现术后皮肤红斑，这种情况通常被称为红乳房综合征。本研究旨在更好地了解这种现象。对 2017 年 4 月至 2018 年 6 月在作者所在机构接受脱细胞真皮基质和植入物乳房重建并接受手术治疗的红乳房综合征连续患者进行了分析。手术中，采集 1cm 大小的脱细胞真皮基质样本，并通过扫描电子显微镜进行分析。观察结果用于评分和记录生物膜的存在和厚度，并鉴定细菌。这些测量使用 Adobe Photoshop CS6 Extended 软件进行。纳入了 6 例乳腺癌根治术后乳房重建患者，均采用 AlloDerm Ready-to-Use 重建。所有标本均被各种细菌定植，包括革兰氏阴性杆菌和革兰氏阳性微生物。所有研究标本均存在生物膜。覆盖脱细胞真皮基质移植物的皮肤红斑，即所谓的红乳房综合征，其原因可能与各种细菌污染有关。尽管分析样本中普遍存在污染，但其实践意义是可变的。即使挽救基于脱细胞真皮基质的重建，也可能以慢性局部炎症为代价。
