Schwartz Jean-Claude D
Department of Surgery, Northside Hospital, Gwinnett Surgical Specialists, 631 Professional Drive Suite 300, Lawrenceville, GA 30046, USA.
JPRAS Open. 2022 Mar 8;32:93-97. doi: 10.1016/j.jpra.2022.02.011. eCollection 2022 Jun.
Morbidly obese patients who undergo reconstruction with implants after mastectomy are at higher risk of reconstructive failure. Prosthetic infection historically required explantation with plans for delayed implant-based reconstruction or conversion to autologous tissue. Loss of the skin envelope in the delayed setting often leads to poor aesthetic outcomes. Recently, several different approaches for salvage of infected implant-based reconstructions with immediate prosthetic replacement have been described. While these strategies have proven useful in many patients, we find a prohibitive risk of failure of this approach in the morbidly obese, especially in those undergoing chemotherapy or who have been radiated. Instead, we have offered these patients salvage of their reconstructions with explantation and immediate autologous conversion to a muscle-sparing latissimus dorsi flap. Here, we report on 11 morbidly obese patients where this strategy was utilized.
接受乳房切除术后植入物重建的病态肥胖患者发生重建失败的风险更高。从历史上看，假体感染需要取出假体，并计划进行延迟的基于植入物的重建或转换为自体组织。在延迟情况下皮肤包膜的丧失往往导致美学效果不佳。最近，已经描述了几种不同的方法来挽救感染的基于植入物的重建并立即更换假体。虽然这些策略在许多患者中已被证明是有用的，但我们发现在病态肥胖患者中，这种方法的失败风险过高，尤其是在接受化疗或接受过放疗的患者中。相反，我们为这些患者提供了通过取出假体并立即将自体组织转换为保留肌肉的背阔肌皮瓣来挽救其重建的方法。在此，我们报告了11例采用该策略的病态肥胖患者。
