Ahmed Shahnur, Hulsman Luci, Imeokparia Folasade, Ludwig Kandice, Fisher Carla, Bamba Ravinder, Danforth Rachel, VonDerHaar R Jason, Lester Mary E, Hassanein Aladdin H
From the Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Ind.
Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, Ind.
Plast Reconstr Surg Glob Open. 2024 Sep 3;12(9):e6116. doi: 10.1097/GOX.0000000000006116. eCollection 2024 Sep.
Implant infection is problematic in breast reconstruction. Traditionally, infected tissue expanders (TE)/implants are removed for several months before replacement, resulting in breast reconstruction delay. Salvage involving device removal, negative pressure wound therapy with instillation and dwell (NPWTi-d) placement, and early staged TE/implant replacement within a few days has been described. The purpose of this study was to compare outcomes of the NPWTi-d salvage pathway with traditional implant removal.
A retrospective review was performed on patients who underwent implant-based reconstruction and developed TE/implant infection/exposure requiring removal. Patients were divided into two groups. Group 1 had TE/implant removal, NPWTi-d placement, and TE/implant replacement 1-4 days later. Group 2 (control) underwent standard TE/implant removal and no NPWTi-d. Reinfection after TE/implant salvage, TE/implant-free days, and time to final reconstruction were assessed.
The study included 47 patients (76 TE/implants) in group 1 (13 patients, 16 TE/implants) and group 2 (34 patients, 60 TE/implants). The success rate (no surgical-site infection within 90 days) of implant salvage was 81.3% in group 1. No group 1 patients abandoned completing reconstruction after TE/implant loss versus 38.2% (13 of 34) in group 2 ( = 0.0094). Mean implant-free days was 2.5 ± 1.2 in group 1 versus 134.6 ± 78.5 in group 2 ( = 0.0001). The interval to final implant-based reconstruction was 69.0 ± 69.7 days in group 1 versus 225.6 ± 93.6 days in group 2 ( = 0.0001).
A breast implant salvage pathway with infected device removal, NPWTi-d placement, and early TE/implant replacement was successful in 81.3%. Patients experienced 132 less implant-free days and faster time to final reconstruction.
植入物感染在乳房重建中是个难题。传统上，感染的组织扩张器（TE）/植入物在更换前需取出数月，导致乳房重建延迟。已有报道采用包括取出装置、放置滴注式负压伤口治疗（NPWTi-d）以及在数天内进行早期分期的TE/植入物更换的挽救方法。本研究的目的是比较NPWTi-d挽救途径与传统植入物取出的效果。
对接受基于植入物的重建且发生需要取出的TE/植入物感染/外露的患者进行回顾性研究。患者分为两组。第1组患者取出TE/植入物，放置NPWTi-d，并在1 - 4天后更换TE/植入物。第2组（对照组）进行标准的TE/植入物取出，不放置NPWTi-d。评估TE/植入物挽救后的再感染情况、无TE/植入物天数以及最终重建时间。
本研究纳入第1组47例患者（76个TE/植入物）（13例患者，16个TE/植入物）和第2组34例患者（60个TE/植入物）。第1组植入物挽救的成功率（90天内无手术部位感染）为81.3%。第1组没有患者在TE/植入物丢失后放弃完成重建，而第2组为38.2%（34例中的13例）（P = 0.0094）。第1组平均无植入物天数为2.5±1.2天，第2组为134.6±78.5天（P = 0.0001）。第1组至最终基于植入物重建的间隔时间为69.0±69.7天，第2组为225.6±93.6天（P = 0.0001）。
一种包括取出感染装置、放置NPWTi-d以及早期更换TE/植入物的乳房植入物挽救途径成功率为81.3%。患者的无植入物天数减少了132天，最终重建时间更快。
