Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Plast Reconstr Aesthet Surg. 2020 Dec;73(12):2156-2163. doi: 10.1016/j.bjps.2020.05.065. Epub 2020 May 26.
The use of acellular dermal matrix (ADM) in immediate breast reconstruction (IBR) continues to rise despite ongoing concerns with respect to increased complication rates. While the indications for radiation continue to broaden, it is essential to critically evaluate ADM's performance in its context. The purpose of this study was to review complication rates between patients reconstructed with and without ADM, who underwent IBR and radiation.
A retrospective review was performed for patients undergoing IBR and radiation from 2010 to 2019. Postoperative outcomes were compared between patients with and without ADM.
Over a 9-year period, 130 patients underwent IBR and radiation (42% preoperatively and 59% postoperatively). For patients with preoperative radiation (36 ADM and 18 non-ADM), the average follow-up was 312 and 296 days, respectively. In this group, there was no difference in minor complications (25% ADM, 22% non-ADM, and p = 1.00) or major complications (31% ADM, 22% Non-ADM, and p = 0.52). For patients with postoperative radiation (53 ADM and 23 non-ADM), the average follow-up was 544 and 748 days, respectively. There was no difference in minor complications (21% ADM, 26% non-ADM, and p = 0.11) or major complications (21% ADM, 26% non-ADM, and p = 0.61). Multivariable logistic regression analyses showed no difference between ADM and non-ADM groups (OR 0.83, 95% CI 0.22-3.08, and p = 0.78).
Despite increasing literature supporting the use of ADM in breast reconstruction, postoperative outcomes following radiation remain poorly understood. In the present study, we report no difference in overall complication rates between breasts reconstructed with and without ADM in an irradiated field. Nevertheless, the complication rate remains high, and future studies will be required to determine whether ADM-associated complications in an irradiated field outweigh the purported benefits.
尽管人们对增加并发症发生率的问题持续存在担忧，但脱细胞真皮基质 (ADM) 在即刻乳房重建 (IBR) 中的应用仍在不断增加。随着放射治疗的适应证不断扩大，至关重要的是要批判性地评估 ADM 在这种情况下的表现。本研究旨在回顾接受 IBR 和放射治疗的患者中，有和没有使用 ADM 的患者的并发症发生率。
对 2010 年至 2019 年期间接受 IBR 和放射治疗的患者进行回顾性研究。比较有和没有 ADM 的患者的术后结果。
在 9 年期间，130 例患者接受了 IBR 和放射治疗（术前 42%，术后 59%）。对于术前接受放射治疗的患者（36 例 ADM 和 18 例非 ADM），平均随访时间分别为 312 天和 296 天。在这一组中，轻微并发症（ADM 组 25%，非 ADM 组 22%，p=1.00）或主要并发症（ADM 组 31%，非 ADM 组 22%，p=0.52）无差异。对于术后接受放射治疗的患者（53 例 ADM 和 23 例非 ADM），平均随访时间分别为 544 天和 748 天。轻微并发症（ADM 组 21%，非 ADM 组 26%，p=0.11）或主要并发症（ADM 组 21%，非 ADM 组 26%，p=0.61）无差异。多变量逻辑回归分析显示，ADM 组与非 ADM 组之间无差异（OR 0.83，95%CI 0.22-3.08，p=0.78）。
尽管越来越多的文献支持在乳房重建中使用 ADM，但在接受放射治疗后，其术后结果仍知之甚少。在本研究中，我们报告在接受放射治疗的区域中，使用和不使用 ADM 重建的乳房在总体并发症发生率方面无差异。然而，并发症发生率仍然很高，需要进一步的研究来确定 ADM 相关并发症在放射治疗区域是否超过了所谓的益处。
