Moyer Hunter R, Sisson Kayla M
From the Monument Health Division of Plastic Surgery, Rapid City, S. Dak.
Idaho College of Osteopathic Medicine, Meridian, Idaho.
Plast Reconstr Surg Glob Open. 2024 Jan 8;12(1):e5507. doi: 10.1097/GOX.0000000000005507. eCollection 2024 Jan.
Two-stage tissue expander to implant surgery remains the predominant technique for breast reconstruction. Unfortunately, there is a high incidence of reconstruction failure which portends a financial and emotional burden. Most failures are related to postmastectomy skin flap necrosis and infection. Recently, a dual-port tissue expander was introduced to the market, and the authors hypothesize that early cultures from the peri-implant fluid will guide antibiotic treatment and decrease reconstruction failure.
This is a cohort study of 50 consecutive patients treated for breast cancer or genetic susceptibility via a two-stage, prepectoral technique. The first 25 patients (46 breasts) were treated with a variety of tissue expanders, and the subsequent 25 patients (47 breasts) received a dual-port expander. Routine cultures from the drain port were taken from the dual-port group at the second postoperative visit, and cultures were taken in the control group only when signs of infection were present. All other procedures and interventions were similar.
Fifty patients, totaling 93 breasts, completed the study with a mean follow-up of 145 days. There were no statistically significant demographic or pathologic differences between groups. Fifteen tissue expanders were explanted in the control group and five in the dual-port cohort (32.6% versus 10.6%, = 0.012). All bacteria in the control group failures were either methicillin-resistant or , whereas failures in the dual-port group varied.
Treatment of routine, early cultures from a dual-port expander led to a statistically significant decrease in tissue expander explantation.
两阶段组织扩张器植入手术仍是乳房重建的主要技术。不幸的是，重建失败的发生率很高，这预示着经济和情感负担。大多数失败与乳房切除术后皮瓣坏死和感染有关。最近，一种双端口组织扩张器已投放市场，作者推测，从植入物周围液体中进行早期培养将指导抗生素治疗并减少重建失败。
这是一项队列研究，对50例通过两阶段胸前置入技术治疗乳腺癌或遗传易感性的连续患者进行研究。前25例患者（46个乳房）接受了各种组织扩张器治疗，随后的25例患者（47个乳房）接受了双端口扩张器。双端口组在术后第二次访视时从引流口进行常规培养，对照组仅在出现感染迹象时进行培养。所有其他程序和干预措施均相似。
50例患者，共93个乳房，完成了研究，平均随访145天。两组之间在人口统计学或病理学上没有统计学上的显著差异。对照组有15个组织扩张器被取出，双端口队列中有5个（32.6%对10.6%，P = 0.012）。对照组失败病例中的所有细菌均为耐甲氧西林金黄色葡萄球菌或表皮葡萄球菌，而双端口组的失败情况各不相同。
对双端口扩张器进行常规早期培养的治疗导致组织扩张器取出率在统计学上显著降低。
