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BACKGROUND AND PURPOSE: Breast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material. MATERIALS AND METHODS: Retrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications. RESULTS: 251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23-9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60-4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97-11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048-0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26-9.99, p = 0.016) were related to late complications. CONCLUSIONS: The overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.
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The author presents an objective review on "Management of Expander and Implant Associated Infections in Breast Reconstruction," discussing different points related to this subject, such as infection definition, identification of risk factors, related microorganisms, surgical techniques, preventive measures, antibiotic prophylaxis and therapy. Flaws in methodologies are identified and points of discrepancy in data and treatment results from previously published studies are pointed out, with discussion of possible causes for these inconsistencies. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Assuntos
Implantes de Mama , Neoplasias da Mama , Infecções , Mamoplastia , Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Seguimentos , Humanos , Mamoplastia/efeitos adversos , Mastectomia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
RESUMEN Introducción: La reconstrucción mamaria por cáncer, mediante la técnica de expansión tisular es una técnica que proporciona piel de color, textura y sensibilidad naturales. Objetivo: Caracterizar la reconstrucción mamaria con el uso de expansores tisulares en el Instituto Nacional de Oncología y Radiobiología de Cuba. Método: Se realizó un estudio retrospectivo y longitudinal en el Servicio de Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología de Cuba del 2013 al 2017. La muestra de 93 pacientes se seleccionó de forma consecutiva del universo de pacientes. El análisis estadístico incluyó las pruebas de Chi-cuadrado, estimación de la razón de momios y regresión logística binaria, con nivel de significación p ≤ 0,05. Resultados: Predominó la reconstrucción en mujeres con un promedio de edad de 45,7 años, [IC95 por ciento (43,8-47,5) y desviación estándar 9.0]. La quimioterapia se administró a 74 pacientes y la radioterapia a 41. La reconstrucción diferida se realizó en el 51,6 por ciento de las cirugías, y en el 72,0 por ciento no se presentaron complicaciones. El cáncer en estadio III y el uso de quimioterapia y radioterapia neoadyuvante mostraron riesgo con significación estadística para las complicaciones posquirúrgicas. Conclusiones: La reconstrucción mamaria mediante el uso de expansores tisulares presentó características demográficas y clínicas similares a las descritas previamente en la población cubana y el resto del mundo, aunque con peculiaridades desde el punto de vista onco-reconstructivo. La realización de la cirugía reconstructiva inmediata luego de la radioterapia neoadyuvante resultó en un mayor riesgo de complicaciones(AU)
ABSTRACT Introduction: Breast reconstruction for cancer, using the tissue expansion technique, is a technique that provides skin of natural color, texture and sensitivity. Objective: To characterize breast reconstruction with the use of tissue expanders at the National Institute of Oncology and Radiobiology of Cuba. Method: A retrospective and longitudinal study was carried out in the Reconstructive Surgery Service of the National Institute of Oncology and Radiobiology of Cuba from 2013 to 2017. The sample of 93 patients was selected consecutively from the universe of patients. Statistical analysis included Chi-square tests, estimation of the odds ratio and binary logistic regression, with a significance level of p ≤ 0,05 Results: Reconstruction predominated in women with an average age of 45.7 years, [95 percent CI (43.8-47.5) and standard deviation 9.0]. Chemotherapy was administered to 74 patients and radiotherapy to 41. Delayed reconstruction was performed in 51.6 percent of the surgeries, and in 72.0 percent there were no complications. Stage III cancer and the use of neoadjuvant chemotherapy and radiotherapy showed a statistically significant risk for postoperative complications. Conclusions: Breast reconstruction by using tissue expanders presented demographic and clinical characteristics similar to those previously described in the Cuban population and the rest of the world, although with peculiarities from the onco-reconstructive point of view. Performing immediate reconstructive surgery after neoadjuvant radiation therapy resulted in an increased risk of complications(AU)
Assuntos
Neoplasias da Mama/tratamento farmacológico , Dispositivos para Expansão de Tecidos/efeitos adversos , Mamoplastia/métodos , Procedimentos de Cirurgia Plástica , Estudos LongitudinaisRESUMO
Nowadays the reconstruction of craniofacial defects can be performed with different kinds of materials, which include the bone and the so-called biomaterials, which have the advantage of not needing a surgical site donor. Among these materials, great attention is given to polymers. In this large group, current attention is focused on the castor oil polymer, since this polymer is biocompatible, low cost, and has adequate strength for reconstruction of the craniomaxillofacial complex. This study aims to report the use of a prosthetic castor oil polymer for reconstruction of extensive defect, caused by a trauma, in the temporoparietal region.
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Los expansores cutáneos son una alternativa reconstructiva de los defectos craneofaciales. Su objetivo es la dilatación progresiva de una zona de piel hasta conseguir un tamaño suficiente para cubrir el defecto. Se presentó la evolución y resultado estético final de un paciente masculino de 32 años de edad con defecto craneofacial por quemaduras eléctricas y el cierre del defecto mediante expansores de tejidos, atendido de conjunto Servicio de Cirugía Reconstructiva y Neurocirugía del Hospital Vladimir Ilich Lenin se obtuvo resultado estético y funcional satisfactorio.
Tissue expanders are one alternative for craniofacial defects. Its objective is the progressive dilation of a region of skin until it achieves a sufficient size to cover the defect. The evolution and aesthetic results in one patient with craniofacial defects by electrical burns was presented. The patient was treated with tissue expanders by the Aesthetic and Neurosurgery Services of Vladimir Ilich Lenin Hospital. The aesthetic and functional results were satisfactory.
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The purpose of this study is to report the use of guinea pigs as experimental model to study the resitance of the tissue expander capsule. Two groups were studied. In both groups a round 20 cc tissue expander, attached to a multiperforated catheter was inserted. The pocket housing was standardized. The skin over the expanded area was tattooed demarcating the area and arc, which were measured before and after each expansion. Every 4 days, a volume corresponding to 10% of the expander's total capacity was injected. Animals of the control group received 3 cc of saline through the catheter at the same time of expansion. Animals of the experimental group received 3 cc of the HBGF-1 diluted with saline. The intraluminal pressure of the expander was measured before and after the injection. After its total filling, the animals were sacrificed and 5 cc more were injected into each expander. The pressure was measured after each 1 cc injected. The capsule was examined histologically by immunofluorescence, trichrome and hematoxylin-eosin stains with the purpose of quantifying collagen and fibroblasts. The experimental model to study the resistance of the tissue expander's capsule showed to be feasible in guinea pigs.
O objetivo deste estudo é relatar o uso de cobaias como modelo experimental para estudar a resistência da cápsula de expansores. Dois grupos foram estudados. Em ambos os grupos um expansor Redondo de 20 ml com um cateter multiperforado fixadoforam inseridos nos animais. A loja foi padronizada. A pele a ser expandida foi tatuada demarcando uma area e um arco que foram medidos a cada expansão. A cada 4 dias. Um volume correspondendo a 10 % da capacidade total do expansor foi injetado. Os animais do grupo controle receberam 3 ml de soro fisiológico pelo catéter de irrigação no mesmo momento da expansão. Os animais do grupo experimental receberam 3 ml de HBGF-1 diluido com soro fisiológico. A pressão intraluminal do expansor foi medida antes e após a injeção. Após o prenchimento total do expansor, os animais foram sacrificados e mais 5 ml foram injetados dentro de cada expansor. A pressão foi medida após cada 1 ml injetado. A cápsula foi examinada histologicamente por immunofluorescência, tricromo e hematoxilina-eosina com a finalidade de quantificar colágeno e fibroblastos. O modelo experimental para estudar a resistência da cápsula do expansor de pele mostrou-se factível em cobaias.
RESUMO
The purpose of this study is to report the use of guinea pigs as experimental model to study the resitance of the tissue expander capsule. Two groups were studied. In both groups a round 20 cc tissue expander, attached to a multiperforated catheter was inserted. The pocket housing was standardized. The skin over the expanded area was tattooed demarcating the area and arc, which were measured before and after each expansion. Every 4 days, a volume corresponding to 10% of the expander's total capacity was injected. Animals of the control group received 3 cc of saline through the catheter at the same time of expansion. Animals of the experimental group received 3 cc of the HBGF-1 diluted with saline. The intraluminal pressure of the expander was measured before and after the injection. After its total filling, the animals were sacrificed and 5 cc more were injected into each expander. The pressure was measured after each 1 cc injected. The capsule was examined histologically by immunofluorescence, trichrome and hematoxylin-eosin stains with the purpose of quantifying collagen and fibroblasts. The experimental model to study the resistance of the tissue expander's capsule showed to be feasible in guinea pigs.
O objetivo deste estudo é relatar o uso de cobaias como modelo experimental para estudar a resistência da cápsula de expansores. Dois grupos foram estudados. Em ambos os grupos um expansor Redondo de 20 ml com um cateter multiperforado fixadoforam inseridos nos animais. A loja foi padronizada. A pele a ser expandida foi tatuada demarcando uma area e um arco que foram medidos a cada expansão. A cada 4 dias. Um volume correspondendo a 10 % da capacidade total do expansor foi injetado. Os animais do grupo controle receberam 3 ml de soro fisiológico pelo catéter de irrigação no mesmo momento da expansão. Os animais do grupo experimental receberam 3 ml de HBGF-1 diluido com soro fisiológico. A pressão intraluminal do expansor foi medida antes e após a injeção. Após o prenchimento total do expansor, os animais foram sacrificados e mais 5 ml foram injetados dentro de cada expansor. A pressão foi medida após cada 1 ml injetado. A cápsula foi examinada histologicamente por immunofluorescência, tricromo e hematoxilina-eosina com a finalidade de quantificar colágeno e fibroblastos. O modelo experimental para estudar a resistência da cápsula do expansor de pele mostrou-se factível em cobaias.