Slovacek Cedar, Asaad Malke, Mitchell David, Selber Jesse C, Clemens Mark W, Chu Carrie K, Mericli Alexander F, Robb Geoffrey L, Hanson Summer E, Butler Charles E
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
Plast Reconstr Surg Glob Open. 2022 Aug 24;10(8):e4409. doi: 10.1097/GOX.0000000000004409. eCollection 2022 Aug.
The goal of this study was to assess whether adding a latissimus dorsi (LD) flap to a secondary implant-based reconstruction (IBR) improves outcomes following explantation of the primary device due to infection.
We conducted a retrospective study of patients who underwent a second IBR with or without the addition of an LD flap during 2006-2019, following explantation due to infection. Surgical outcomes were collected and compared between reconstruction types.
A total of 6093 IBRs were identified during the study period. Of these, 109 underwent a second attempt at breast reconstruction with IBR alone (n = 86, 79%) or IBR/LD (n = 23, 21%) following explantation of an infected device. Rates of secondary device explantation due to a complication were similar between the two groups (26% in the IBR/LD group and 21% in the IBR group; = 0.60). Among the patients who underwent prior radiotherapy, the IBR/LD group had lower rates of any complication (38% versus 56%; = 0.43), infection (25% versus 44%; = 0.39), and reconstruction failure (25% versus 44%; = 0.39); however, differences were not statistically significant.
Following a failed primary breast reconstruction due to infection, it may be appropriate to offer a secondary reconstruction. For patients with a history of radiotherapy, combining an LD flap with IBR may provide benefits over IBR alone. Although not statistically different, this outcome may have clinical significance, considering the magnitude of the effect, and may result in decreased complication rates and a higher chance of reconstructive success.
本研究的目的是评估在基于植入物的二期乳房重建（IBR）中添加背阔肌（LD）皮瓣是否能改善因感染而取出初次植入装置后的手术效果。
我们对2006年至2019年期间因感染而取出初次植入装置后接受二期IBR（无论是否添加LD皮瓣）的患者进行了一项回顾性研究。收集并比较了不同重建类型的手术结果。
在研究期间共识别出6093例IBR。其中，109例在感染装置取出后单独接受了二期IBR乳房重建（n = 86，79%）或IBR/LD重建（n = 23，21%）。两组因并发症导致的二期装置取出率相似（IBR/LD组为26%，IBR组为21%；P = 0.60）。在接受过先前放疗的患者中，IBR/LD组的任何并发症发生率（38%对56%；P = 0.43）、感染率（25%对44%；P = 0.39）和重建失败率（25%对44%；P = 0.39）较低；然而，差异无统计学意义。
因感染导致初次乳房重建失败后，进行二期重建可能是合适的。对于有放疗史的患者，将LD皮瓣与IBR联合使用可能比单纯IBR更有益。尽管在统计学上没有差异，但考虑到效果的大小，这一结果可能具有临床意义，并可能导致并发症发生率降低和重建成功的机会增加。
