Gibstein Alexander R, Chaudhry Aneeq S, Loureiro Rita, Thomas Charo, Salinas Harry, Treiser Matthew, Medina Miguel A
From the Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL.
Division of Plastic and Reconstructive Surgery, Baptist Health South Florida, Miami Cancer Institute, Miami, FL.
Plast Reconstr Surg Glob Open. 2025 Jun 16;13(6):e6845. doi: 10.1097/GOX.0000000000006845. eCollection 2025 Jun.
Implant-based (IB) breast reconstruction is efficient and predictable but poses infection risks, especially in patients with high body mass index and/or macromastia. Postoperative infection management lacks standardized protocols for device salvage.
We conducted a 1-year retrospective study on 59 high-risk patients (91 breasts) using dual-port tissue expanders for breast reconstruction. A Wise-pattern skin envelope reduction closed over an inferiorly based adipodermal lining flap was used. Using the dual port, a closed washout protocol with a Betadine solution was initiated for suspected infections. Patient characteristics, infection profiles, and outcomes were recorded. A control cohort of 54 patients (98 breasts) without dual-port expanders was analyzed for infection rates and outcomes.
In the experimental cohort, 18% of breasts had postoperative infections, with 38% successfully salvaged using oral antibiotics and the closed washout alone. The overall salvage rate was 75%, and the infectious reconstructive failure rate was 3.3%. Gram-positive bacteria were predominant. The control cohort had a 23.5% infection rate, with only 5% successful salvage and 19 explantations. No statistically significant differences in demographics or infection rates were observed.
The study demonstrated the efficacy of a closed wash protocol with dual-port tissue expanders in high-risk IB breast reconstruction. This approach reduces surgical washouts, improves salvage rates, and minimizes reconstruction losses. The dual-port expander shows promise in enhancing salvage outcomes and decreasing reoperations for postoperative infections, providing a valuable addition to IB breast reconstruction strategies. The results suggest potential benefits of the dual-port expander in infection treatment.
植入式（IB）乳房重建有效且可预测，但存在感染风险，尤其是在体重指数高和/或巨乳症患者中。术后感染管理缺乏用于器械挽救的标准化方案。
我们对59例使用双端口组织扩张器进行乳房重建的高危患者（91个乳房）进行了为期1年的回顾性研究。采用了一种改良的Wise皮瓣技术，在下方的脂肪真皮衬里皮瓣上关闭皮肤包膜。对于疑似感染，通过双端口启动了用碘伏溶液进行的封闭冲洗方案。记录患者特征、感染情况和结果。分析了54例（98个乳房）未使用双端口扩张器的对照队列的感染率和结果。
在实验队列中，18%的乳房发生术后感染，其中38%仅通过口服抗生素和封闭冲洗成功挽救。总体挽救率为75%，感染性重建失败率为3.3%。革兰氏阳性菌占主导。对照队列的感染率为23.5%，仅5%成功挽救，19例取出植入物。在人口统计学或感染率方面未观察到统计学上的显著差异。
该研究证明了双端口组织扩张器在高危IB乳房重建中进行封闭冲洗方案的有效性。这种方法减少了手术冲洗，提高了挽救率，并使重建损失最小化。双端口扩张器在提高挽救结果和减少术后感染的再次手术方面显示出前景，为IB乳房重建策略提供了有价值的补充。结果表明双端口扩张器在感染治疗中具有潜在益处。
