Sala Laura, Bonomi Stefano, Fabbri Alessandra, Ciniselli Chiara Maura, Bardelli Annalisa, Verderio Paolo, Pruneri Giancarlo, Cortinovis Umberto
Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milano University of Milan, School of Medicine, Milano, Italy.
Tumori. 2023 Feb;109(1):86-96. doi: 10.1177/03008916211056072. Epub 2021 Oct 31.
Implant-based breast reconstruction in the setting of radiotherapy often leads to higher complications rates (mainly capsular contracture and wound dehiscence) and poor cosmetic outcomes. We hypothesized that the combination of pulsed-electron avalanche knife (PEAK) PlasmaBlade (a pulsed radiofrequency electrosurgery) and acellular dermal matrix Veritas® in postmastectomy radiotherapy implant-based breast reconstruction could result in lower complications rate, better reconstructive results, and patient satisfaction.
A prospective observational study focused on the use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy was carried out in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano between December 2017 and 2019 (2017-2018: enrollment; 2018-2019: follow-up). Patient demographics were queried and complication rates and patient and surgeon satisfaction were assessed.
A total of 88 patients were enrolled; 2 patients received bilateral reconstruction, leading to a total of 90 procedures. Sixty-two women received contralateral symmetrization. Seroma was the most frequent minor complication (8.8%); implant exposure was the most recorded among major complications (5.5%). Preoperative lipofilling was the most substantial protective factor for preventing complications ( < 0.001). A significant association between capsular thermal damage thickness and the type of electrosurgery used (traditional electrosurgery vs PEAK PlasmaBlade) was observed, with lower values with PEAK PlasmaBlade ( < 0.0001).
Our protocol results in low rates of surgical complications and a high level of patient and surgeon satisfaction although longer follow-up is needed.
在放疗背景下进行基于植入物的乳房重建通常会导致更高的并发症发生率（主要是包膜挛缩和伤口裂开）以及较差的美容效果。我们假设，在乳房切除术后放疗的基于植入物的乳房重建中，脉冲电子雪崩刀（PEAK）PlasmaBlade（一种脉冲射频电外科设备）与脱细胞真皮基质Veritas®联合使用可降低并发症发生率，获得更好的重建效果和患者满意度。
2017年12月至2019年期间，在米兰 Fondazione IRCCS Istituto Nazionale Tumori 的整形重建外科开展了一项前瞻性观察研究，重点关注PEAK PlasmaBlade在基于植入物的乳房重建和放疗中的应用（2017 - 2018年：入组；2018 - 2019年：随访）。查询了患者人口统计学资料，并评估了并发症发生率以及患者和外科医生的满意度。
共纳入88例患者；2例接受双侧重建，共进行了90次手术。62名女性接受了对侧对称化手术。血清肿是最常见的轻微并发症（8.8%）；植入物外露是记录最多的主要并发症（5.5%）。术前脂肪填充是预防并发症的最重要保护因素（<0.001）。观察到包膜热损伤厚度与所用电外科类型（传统电外科与PEAK PlasmaBlade）之间存在显著关联，PEAK PlasmaBlade的值较低（<0.0001）。
尽管需要更长时间的随访，但我们的方案导致手术并发症发生率较低，患者和外科医生满意度较高。
