Kong Tae Hyun, Chung Kyu-Jin, Kim Taegon, Lee Jun-Ho
Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.
Gland Surg. 2022 Aug;11(8):1301-1308. doi: 10.21037/gs-22-175.
The use of an acellular dermal matrix is advantageous for direct-to-implant breast reconstruction after skin-preserving mastectomy, but is associated with postoperative complications, especially increased seroma. Therefore, this study aimed to determine whether acellular dermal matrix surface area and thickness are associated with an increased risk of seroma.
This retrospective chart review was based on the medical records of patients who underwent submuscular direct-to-implant breast reconstruction from January 2011 to June 2018 by a single surgeon. The acellular dermal matrices were divided into groups according to surface area and thickness (group I, thin and small; group II, thin and large; group III, thick and small; and group IV, thick and large). The drainage volume and period were analyzed between the groups using an analysis of variance. The factors influencing drainage were analyzed using Pearson correlation coefficients.
Of the 219 cases of direct-to-implant breast reconstruction (217 patients), 77, 63, 42, and 37 were in groups I, II, III, and IV, respectively. A large acellular dermal matrix resulted in a larger drainage volume, longer drainage period, and more complications. The drainage volume increased as the body mass index (r=0.217; P<0.01), mastectomy volume (r=0.358; P<0.01), and implant volume (r=0.385; P<0.01) increased. There was no difference in drainage volume, drainage period, and complications depending on the thickness and manufacturer of the acellular dermal matrix.
In direct-to-implant breast reconstruction, the use of a larger acellular dermal matrix, not a thicker acellular dermal matrix, increases the drainage volume and period, thereby resulting in a greater risk of seroma or infection.
在保乳乳房切除术后直接植入式乳房重建中，使用脱细胞真皮基质具有优势，但与术后并发症相关，尤其是血清肿增加。因此，本研究旨在确定脱细胞真皮基质的表面积和厚度是否与血清肿风险增加相关。
本回顾性图表审查基于2011年1月至2018年6月由单一外科医生进行的肌下直接植入式乳房重建患者的病历。根据表面积和厚度将脱细胞真皮基质分为几组（I组，薄且小；II组，薄且大；III组，厚且小；IV组，厚且大）。使用方差分析在各组之间分析引流量和引流期。使用Pearson相关系数分析影响引流的因素。
在219例直接植入式乳房重建病例（217例患者）中，I组、II组、III组和IV组分别有77例、63例、42例和37例。大的脱细胞真皮基质导致更大的引流量、更长的引流期和更多的并发症。随着体重指数（r = 0.217；P < 0.01）、乳房切除量（r = 0.358；P < 0.01）和植入物体积（r = 0.385；P < 0.01）增加，引流量增加。根据脱细胞真皮基质的厚度和制造商，引流量、引流期和并发症没有差异。
在直接植入式乳房重建中，使用更大的脱细胞真皮基质而非更厚的脱细胞真皮基质会增加引流量和引流期，从而导致血清肿或感染的风险更高。
