Antognoli Lauren E, Singh Devinder P, Choudhry Salman, Turcotte Justin, Holton Luther H
Rebecca Fortney Breast Center at Anne Arundel Medical Center, Annapolis, Md.
University of Miami Health System and Miller School of Medicine, Miami, Fla.
Plast Reconstr Surg Glob Open. 2021 Oct 29;9(10):e3896. doi: 10.1097/GOX.0000000000003896. eCollection 2021 Oct.
Existing salvage protocols for infected breast prostheses using negative pressure wound therapy with instillation and dwell (NPWTi-d) require multiple returns to the operating room and prolonged length of stay. We present our expedited salvage protocol and discuss outcomes and associated costs savings.
Using a retrospective review, we identified 25 consecutive patients (27 breasts) with peri-prosthetic breast infection. Nine patients (10 breasts) underwent removal of infected breast prostheses followed by autologous or staged implant-based reconstruction. Sixteen patients (17 breasts) underwent our single application salvage protocol. A cost analysis was performed comparing the two groups, and an economic model was used to project the cost savings associated with using single application NPWTi-d protocol.
Fifteen of the 16 patients (94%) who underwent single application NPWTi-d had successful implant salvage. Average duration of NPWTi-d was 2 days, 7 hours, and average length of stay was 4.43 days. Compared to control, patients who received the single application protocol required significantly fewer hospitalizations and office visits. A total savings of $58,275 could have been achieved by using the single application NPWTi-d protocol in the patients who did not undergo NPWTi-d.
Single application of NPWTi-d is a simple, safe, and cost-effective technique for salvage of breast prostheses, with 94% success rate, even in immunocompromised patients and severe infection. Compared to previous protocols, ours requires fewer trips to the operating room, shorter length of stay, and more permanent implants placed during salvage. Our protocol is also associated with fewer office visits and fewer returns to the operating room.
现有的使用负压伤口治疗联合滴注与驻留（NPWTi-d）的感染性乳房假体挽救方案需要多次返回手术室且住院时间延长。我们介绍我们的快速挽救方案，并讨论其结果及相关成本节约情况。
通过回顾性研究，我们确定了25例连续的假体周围乳房感染患者（27侧乳房）。9例患者（10侧乳房）接受了感染性乳房假体移除，随后进行自体或分期植入式重建。16例患者（17侧乳房）接受了我们的单次应用挽救方案。对两组进行了成本分析，并使用经济模型来预测与使用单次应用NPWTi-d方案相关的成本节约情况。
接受单次应用NPWTi-d的16例患者中有15例（94%）成功挽救了植入物。NPWTi-d的平均持续时间为2天7小时，平均住院时间为4.43天。与对照组相比，接受单次应用方案的患者住院和门诊就诊次数明显更少。在未接受NPWTi-d的患者中使用单次应用NPWTi-d方案总共可节省58,275美元。
单次应用NPWTi-d是一种简单、安全且具有成本效益的乳房假体挽救技术，成功率为94%，即使在免疫功能低下患者和严重感染患者中也是如此。与以前的方案相比，我们的方案需要更少的手术室就诊次数、更短的住院时间，并且在挽救过程中植入的永久性植入物更多。我们的方案还与更少的门诊就诊次数和更少的手术室返回次数相关。
