Clark Robert Craig, Cevallos Priscila, Dadpey Benyamin, Yessaillian Andrea, Turner Elizabeth, Kang Augustine, Thornton Brian, Nazerali Rahim, Reid Chris M
From the Division of Plastic Surgery, University of California, San Diego Health.
Division of Plastic and Reconstructive Surgery, Stanford University.
Plast Reconstr Surg. 2025 Jun 1;155(6):974e-985e. doi: 10.1097/PRS.0000000000011832. Epub 2024 Oct 18.
Infection following tissue expander (TE) breast reconstruction is frequent and impactful. Preliminary reports demonstrate value of local antibiotic delivery for implant salvage and prophylactic potential. This article is a multiinstitutional retrospective study using surgeon-crafted tobramycin-vancomycin polymethyl methacrylate plates (prophylactic local antibiotics for tissue expansion [PLATE]) during TE implantation for infection prophylaxis. The authors hypothesized that the intervention would be associated with fewer infections compared with historical practice.
In 2021, surgeons at 3 institutions began independently offering PLATE for primary TE breast reconstructions. After independent institutional review board approvals, data were retrospectively collected for PLATE subjects and preintervention cohorts of equivalent sizes. Subjects were followed up for 7 months, or to second-stage removal. The primary outcome-complication requiring readmission/reoperation-was compared between aggregated cohorts. Analysis included logistic modeling and Kaplan-Meyer survival.
The aggregate sample included 183 intervention subjects (292 breasts) and 183 controls (301 breasts), each with 5 ± 2-month follow-up. Overall, complications were significantly less frequent with PLATE (13.1% versus 21.9%; P < 0.01). This was driven by significantly fewer infections (4.8% versus 12.6%; P < 0.01) with no difference in rates of tissue necrosis, seroma, or other complications ( P > 0.05). In multivariable regression, the intervention was associated with significantly reduced odds of any complication (OR, 0.53; 95% CI, 0.3 to 0.93) and infection (OR, 0.22; 95% CI, 0.08 to 0.50). Kaplan-Meyer curves demonstrated significant longitudinal reduction in complication and infection ( P < 0.01) without notable rebound throughout dissipation of the antibiotic eluent.
Prophylactic use of intraoperatively crafted PLATE during TE implantation was associated with significant infection reduction without increase in local or systemic complications. This reproducible tool may be highly valuable in alloplastic breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
组织扩张器（TE）乳房重建术后感染很常见且影响较大。初步报告显示局部抗生素给药对植入物挽救具有价值并有预防潜力。本文是一项多机构回顾性研究，在TE植入期间使用外科定制的妥布霉素-万古霉素聚甲基丙烯酸甲酯板（组织扩张预防性局部抗生素[PLATE]）进行感染预防。作者假设与既往做法相比，该干预措施会减少感染的发生。
2021年，3家机构的外科医生开始独立为初次TE乳房重建提供PLATE。经各机构独立伦理审查委员会批准后，对PLATE组受试者和同等规模的干预前队列进行回顾性数据收集。对受试者随访7个月，或至二期取出。比较汇总队列之间的主要结局——需要再次入院/再次手术的并发症。分析包括逻辑建模和Kaplan-Meyer生存分析。
汇总样本包括183例干预组受试者（292侧乳房）和183例对照组受试者（301侧乳房），每组的随访时间均为5±2个月。总体而言，PLATE组的并发症明显更少（13.1%对21.9%；P<0.01）。这主要是由于感染显著减少（4.8%对12.6%；P<0.01），而组织坏死、血清肿或其他并发症的发生率无差异（P>0.05）。在多变量回归分析中，该干预措施与任何并发症（比值比[OR]，0.53；95%置信区间[CI]，0.3至0.93）和感染（OR，0.22；95%CI，0.08至0.50）的发生几率显著降低相关。Kaplan-Meyer曲线显示并发症和感染在纵向方面显著减少（P<0.01），在抗生素洗脱液消散过程中无明显反弹。
在TE植入期间预防性使用术中定制的PLATE可显著减少感染，且不会增加局部或全身并发症。这种可重复使用的工具在假体乳房重建中可能具有很高的价值。
临床问题/证据级别：治疗性，III级
