脱细胞真皮基质与网片在胸肌前和胸肌下一期直接植入重建中的术后并发症比较：一项回顾性队列研究
Comparative Postoperative Complications of Acellular Dermal Matrix and Mesh Use in Prepectoral and Subpectoral One-Stage Direct to Implant Reconstruction: A Retrospective Cohort Study.
作者信息
Diffley Michael, Tang Amy, Sawar Kinan, Al-Saghir Tala, Gonte Madeleine R, Hall Jamie, Tepper Donna, Darian Vigen, Evangelista Maristella, Atisha Dunya
机构信息
From the Division of General Surgery, Henry Ford Health, Detroit, MI.
Public Health Sciences, Henry Ford Health, Detroit, MI.
出版信息
Ann Plast Surg. 2025 May 1;94(5):521-527. doi: 10.1097/SAP.0000000000004233. Epub 2025 Jan 27.
BACKGROUND
One-stage direct-to-implant (DTI) breast reconstruction is increasingly popular with the use of prepectoral reconstruction leading to increased demand for structural scaffolds. It is vital to determine if differences in safety profiles exist among scaffolds.
METHODS
We performed a retrospective cohort study of consecutive patients in our breast cancer center undergoing DTI reconstruction. Outcomes relating to postoperative infections, wound complications, and implant related complications were extracted. Outcomes were grouped into major, minor, and long-term complications. Univariate and multivariate analysis determined outcome differences and accounted for confounding variables.
RESULTS
Two hundred forty-two patients (404 breasts) underwent DTI reconstruction. One hundred ninety-two breasts were reconstructed with FlexHD Pliable Preformed (PP; MTF Biologics, Edison, NJ), 122 with AlloDerm Ready To Use (RTU; Allergan Aesthetics, Irvine, CA), 22 with DermACELL (LifeNet Health, Virginia Beach, VA), 21 with Galaflex (Galatea Surgical, Lexington, MA), 22 with Meso BioMatrix (MTF Biologics), and 25 with autologous dermal flaps alone. Univariate analysis demonstrated statistically significant differences among scaffolds in the incidence of cellulitis treated with oral antibiotics, capsular contracture, explantation for capsular contracture, seroma requiring operative drainage, minor complications, and long-term complications. On multivariate regression, FlexHD PP had reduced rates of capsular contracture, explantation for capsular contracture, minor complications, and long-term complications compared to AlloDerm RTU. Reconstruction with Galaflex had increased rates of capsular contracture when compared to FlexHD PP.
CONCLUSIONS
Certain structural scaffolds have differing safety profiles that should be considered when selecting, which product to use in DTI reconstruction.
背景
随着胸肌前重建技术的应用，一期直接植入式（DTI）乳房重建越来越受欢迎，这导致对结构支架的需求增加。确定不同支架之间的安全性是否存在差异至关重要。
方法
我们对乳腺癌中心接受DTI重建的连续患者进行了一项回顾性队列研究。提取了与术后感染、伤口并发症和植入物相关并发症有关的结果。结果分为主要、次要和长期并发症。单因素和多因素分析确定了结果差异并考虑了混杂变量。
结果
242例患者（404侧乳房）接受了DTI重建。192侧乳房使用FlexHD可弯曲预成型（PP；MTF生物制品公司，新泽西州爱迪生）进行重建，122侧使用即用型AlloDerm（RTU；艾尔建美学公司，加利福尼亚州欧文），22侧使用DermACELL（生命网健康公司，弗吉尼亚州弗吉尼亚海滩），21侧使用Galaflex（加拉泰亚外科公司，马萨诸塞州列克星敦），22侧使用Meso BioMatrix（MTF生物制品公司），25侧仅使用自体真皮瓣。单因素分析表明，在口服抗生素治疗蜂窝织炎的发生率、包膜挛缩、因包膜挛缩取出植入物、需要手术引流的血清肿、次要并发症和长期并发症方面，不同支架之间存在统计学显著差异。多因素回归分析显示，与即用型AlloDerm相比，FlexHD PP的包膜挛缩、因包膜挛缩取出植入物、次要并发症和长期并发症发生率较低。与FlexHD PP相比，使用Galaflex进行重建的包膜挛缩发生率更高。
结论
在选择DTI重建中使用哪种产品时，应考虑某些结构支架具有不同的安全性。
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