Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089 Rozzano Milan, Italy.
Scuola di Specializzazione in Microbiologia e Virologia, Università degli Studi di Pavia, 27100 Pavia, Italy.
Biomed Res Int. 2021 Mar 19;2021:6650846. doi: 10.1155/2021/6650846. eCollection 2021.
Surgical site infection represents the most severe complication in prosthetic breast reconstruction. Risk profiling represents a useful tool for both clinicians and patients.
In our hospital, 534 breast reconstructions with tissue expander implants, in 500 patients, were performed. Several clinical variables were collected. In our study, we evaluated the different inflammatory markers present in the periprosthetic fluid and we compared them with the ones present in plasma.
The surgical site infection rate resulted to be 10.5%, and reconstruction failed in 4.5% of the cases. The hazard ratio for complications was 2.3 in women over 60 (CI: 1.3-4.07; = 0.004), 2.57 in patients with expander volume ≥ 500 cc (CI: 1.51-4.38; < 0.001), 2.14 in patients submitted to previous radiotherapy (CI: 1.05-4.36; < 0.037), and 1.05 in prolonged drain use (CI: 1.03-1.07; < 0.001). 25-OH, PCT, and total protein were less concentrated, and ferritin and LDH were more concentrated in the periprosthetic fluid than in plasma ( < 0.001). CRP ( = 0.190) and -2 microglobulin ( = 0.344) did not change in the two fluids analyzed. PCT initial value is higher in patients who underwent radiotherapy, and it could be related to the higher rate of their postoperative complications. Patients with a tissue expander with a volume ≥ 500 cc show an increasing trend for CRP in time ( = 0.009).
Several risk factors (prolonged time of drains, age older than 60 years, and radiotherapy) have been confirmed by our study. The study of markers in the periprosthetic fluid with respect to their study in plasma could point toward earlier infection detection and support early management.
假体乳房重建术后的感染是最严重的并发症。风险分析对于临床医生和患者来说都是一个有用的工具。
在我们医院，对 500 名患者的 534 例组织扩张器植入乳房重建术进行了回顾性分析，收集了多项临床变量。在我们的研究中，评估了假体周围液中存在的不同炎症标志物，并将其与血浆中的标志物进行了比较。
手术部位感染率为 10.5%，重建失败率为 4.5%。并发症的危险比为 60 岁以上女性 2.3（95%CI：1.3-4.07；P=0.004）、扩张器体积≥500cc 2.57（95%CI：1.51-4.38；P<0.001）、有放疗史 2.14（95%CI：1.05-4.36；P=0.037）、引流时间延长 1.05（95%CI：1.03-1.07；P<0.001）。假体周围液中 25-羟维生素 D、降钙素原和总蛋白的浓度较低，铁蛋白和乳酸脱氢酶的浓度较高（P<0.001）。在两种分析的液体中，C 反应蛋白（P=0.190）和β2-微球蛋白（P=0.344）均无变化。接受放疗的患者初始降钙素原值较高，这可能与术后并发症发生率较高有关。体积≥500cc 的组织扩张器患者的 CRP 呈时间依赖性增加（P=0.009）。
本研究证实了几个风险因素（引流时间延长、年龄大于 60 岁和放疗）。与在血浆中研究标志物相比，研究假体周围液中的标志物可能有助于更早地发现感染，并支持早期管理。
