From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC.
Drexel University School of Medicine, Philadelphia, PA.
Ann Plast Surg. 2024 Jun 1;92(6S Suppl 4):S419-S422. doi: 10.1097/SAP.0000000000003947.
Tissue expander-based breast reconstruction is associated with high rates of infectious complications, often leading to tissue expander explants and delays in receipt of definitive breast reconstruction and adjuvant therapy. In this study, we describe a single-stage technique where deep inferior epigastric artery perforator (DIEP) flaps are used to salvage actively infected tissue expanders among patients originally planning for free flap reconstruction.
In this technique, patients with tissue expander infections without systemic illness are maintained on oral antibiotics until the day of their DIEP flap surgery, at which time tissue expander explant is performed in conjunction with aggressive attempt at total capsulectomy and immediate DIEP flap reconstruction. Patients are maintained on 1-2 weeks of oral antibiotics tailored to culture data. Patients undergoing this immediate salvage protocol were retrospectively reviewed, and complications and length of stay were assessed.
In a retrospective series, a total of six consecutive patients with culture-proven tissue expander infections underwent tissue expander removal and DIEP flap reconstruction in a single stage and were maintained on 7-14 days of oral antibiotics postoperatively. Within this cohort, no surgical site infections, microvascular complications, partial flap losses, reoperations, or returns to the operating room were noted within a 90-day period.
Among a select cohort of patients, actively infected tissue expanders may be salvaged with free flap breast reconstruction in a single surgery with a low incidence of postoperative complications. Prospective studies are needed to evaluate the influence of this treatment strategy on costs, number of surgeries, and dissatisfaction after staged breast reconstruction complicated by tissue expander infections.
基于组织扩张器的乳房重建与高感染并发症相关，常导致组织扩张器取出和延迟获得确定性乳房重建和辅助治疗。在这项研究中，我们描述了一种单阶段技术，其中使用腹壁下动脉穿支皮瓣（DIEP）挽救最初计划进行游离皮瓣重建的患者中活动性感染的组织扩张器。
在该技术中，无全身疾病的组织扩张器感染患者继续口服抗生素，直到 DIEP 皮瓣手术当天，此时进行组织扩张器取出，并进行积极的全包膜切除术和立即 DIEP 皮瓣重建。患者继续接受 1-2 周根据培养数据定制的口服抗生素治疗。回顾性审查了接受这种即刻挽救方案的患者，评估了并发症和住院时间。
在一项回顾性系列研究中，共有 6 例连续的经培养证实的组织扩张器感染患者在单阶段进行了组织扩张器取出和 DIEP 皮瓣重建，术后接受 7-14 天的口服抗生素治疗。在该队列中，在 90 天内未观察到手术部位感染、微血管并发症、部分皮瓣丢失、再次手术或返回手术室。
在选择的患者群体中，活动性感染的组织扩张器可通过单次手术与游离皮瓣乳房重建联合挽救，术后并发症发生率较低。需要前瞻性研究来评估这种治疗策略对分期乳房重建后组织扩张器感染并发症的成本、手术次数和不满的影响。
