Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
J Plast Reconstr Aesthet Surg. 2021 May;74(5):981-986. doi: 10.1016/j.bjps.2020.10.048. Epub 2020 Nov 2.
The use of acellular dermal matrices (ADMs) in immediate two-stage prosthetic breast reconstruction following mastectomy is now a common practice. The procedure confers several compelling benefits, including coverage of the inferior pole, enhanced definition of the inframammary fold, and reduction of capsular contracture. However, operative techniques used to create the ADM inferolateral sling can be unwieldy in practice, typically involving the placement of the ADM followed by positioning and anchoring of the prosthetic expander. At best, this may be a relatively minor nuisance, but may potentially influence outcomes, including discrepancies in symmetry.
We present a novel modification that aims to streamline this procedure. Perforations are made through the allograft, through which the tissue expander tabs are brought through and sutured together ex vivo to allow the ADM and expander to be placed into the inframammary fold position as a single unit. A retrospective chart review was then performed of patients who underwent breast reconstruction utilizing this technique between July 2015 and December 2018. Outcomes including postsurgical complications such as infection, malposition, and reoperation were analyzed.
Sixty-two patients met the inclusion criteria, corresponding to 108 breasts. The average follow-up was 18 months. The overall complication rate was 29.6% of breasts. The most commonly observed complications were mastectomy skin necrosis (9.3%) and major infection (8.3%). There was a 7.4% rate of malposition.
This simple but effective modification in ADM technique is associated with a comparable complication rate and allows for greater ease and consistency in tissue expander placement.
脱细胞真皮基质（ADM）在乳房切除术后即刻行二期假体乳房重建中的应用现已较为常见。该术式具有许多显著优势，包括覆盖乳房下极、增强乳房下皱襞的形态、减少包膜挛缩。然而，用于制作 ADM 下外侧吊带的手术技术在实际操作中可能较为复杂，通常包括放置 ADM 后再定位和固定假体扩张器。这可能最多只是一个相对较小的麻烦，但可能会潜在地影响手术结果，包括对称性差异。
我们提出了一种新颖的改良方法，旨在简化该手术过程。通过同种异体移植物打孔，将组织扩张器的标签穿过孔并在体外缝合在一起，从而将 ADM 和扩张器作为一个整体放入乳房下皱襞位置。然后对 2015 年 7 月至 2018 年 12 月期间接受该技术乳房重建的患者进行回顾性图表分析。分析了术后并发症，如感染、错位和再次手术等。
符合纳入标准的患者有 62 名，共 108 侧乳房。平均随访时间为 18 个月。总的并发症发生率为 29.6%。最常见的并发症是乳房切除术皮瓣坏死（9.3%）和严重感染（8.3%）。有 7.4%的乳房出现错位。
这种 ADM 技术的简单而有效的改良方法与相似的并发症发生率相关，并且可以更轻松、更一致地进行组织扩张器放置。
