Alameddine Khaled O, Salinas Cristina A, Yan Maria, Martinez-Jorge Jorys, Vijayasekaran Aparna, Tran Nho V, Harless Christin A
Aesthet Surg J Open Forum. 2024 Sep 2;6:ojae073. doi: 10.1093/asjof/ojae073. eCollection 2024.
Implant-based breast reconstruction following radiotherapy can lead to significant postoperative complications. Closed-incision negative pressure wound therapy (ciNPWT) has emerged as a potential intervention to reduce these complications.
To assess the effectiveness of ciNPWT in reducing postoperative complications in patients undergoing implant-based breast reconstruction after radiotherapy.
A retrospective single-center cohort study was conducted, including patients who underwent implant-based breast reconstruction after mastectomy and radiotherapy between January 1, 2015, and December 31, 2022. We utilized a procedure-level analysis model with patients contributing distinct observations for multiple procedures. Our primary outcome measures included fluid collection, infection, and wound complications. Propensity score analysis was employed to adjust for potential confounders, such as BMI, smoking history, and diabetes history, creating a balanced comparison between the ciNPWT-treated and untreated groups.
In our study of 301 breast reconstructions postradiotherapy from 2015 to 2022, encompassing 218 unique patients, we found significant benefits of ciNPWT. During an average of 2.2-year follow-up, the ciNPWT group demonstrated no infections, contrasting with a 10.4% rate in the non-ciNPWT group ( < .0001). Wound complications were also significantly lower in the ciNPWT group (1.9% vs 11.2%; = .00848). Demographic differences were adjusted using inverse probability of treatment weights. The findings suggest ciNPWT's promising role in enhancing postoperative outcomes in breast reconstruction postradiotherapy.
Our study suggests that the use of ciNPWT in implant-based breast reconstruction postradiotherapy can potentially reduce postoperative complications. This intervention can improve patient outcomes and may offer cost-saving benefits in the long run.
放疗后基于植入物的乳房重建可导致显著的术后并发症。闭合切口负压伤口治疗（ciNPWT）已成为一种减少这些并发症的潜在干预措施。
评估ciNPWT在降低放疗后接受基于植入物乳房重建患者术后并发症方面的有效性。
进行了一项回顾性单中心队列研究，纳入2015年1月1日至2022年12月31日期间接受乳房切除术后放疗并进行基于植入物乳房重建的患者。我们采用了一种程序水平分析模型，患者为多个程序贡献不同的观察结果。我们的主要结局指标包括积液、感染和伤口并发症。采用倾向评分分析来调整潜在混杂因素，如体重指数、吸烟史和糖尿病史，从而在ciNPWT治疗组和未治疗组之间进行均衡比较。
在我们对2015年至2022年301例放疗后乳房重建的研究中，涉及218例独特患者，我们发现ciNPWT有显著益处。在平均2.2年的随访期间，ciNPWT组未发生感染，而非ciNPWT组的感染率为10.4%（<0.0001）。ciNPWT组的伤口并发症也显著更低（1.9%对11.2%；P = 0.00848）。使用治疗权重的逆概率调整人口统计学差异。研究结果表明ciNPWT在改善放疗后乳房重建术后结局方面具有良好前景。
我们的研究表明，在放疗后基于植入物的乳房重建中使用ciNPWT可能会降低术后并发症。这种干预措施可以改善患者结局，从长远来看可能还具有节省成本的益处。
