Prophylactic Local Antibiotics for Tissue Expansion (PLATE) Improve Breast Reconstruction Outcomes.

IF 3.2 2区 医学 Q1 SURGERY
Plastic and reconstructive surgery Pub Date : 2025-06-01 Epub Date: 2024-10-18 DOI:10.1097/PRS.0000000000011832
Robert Craig Clark, Priscila Cevallos, Benyamin Dadpey, Andrea Yessaillian, Elizabeth Turner, Augustine Kang, Brian Thornton, Rahim Nazerali, Chris M Reid
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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

用于组织扩张的预防性局部抗生素(PLATE)可改善乳房再造效果。
导言:组织扩张器(TE)乳房再造术后感染的发生率高且影响大。初步报告显示,局部抗生素给药具有挽救植入物和预防感染的价值。本文是一项多机构回顾性研究,研究人员在乳腺组织扩张器植入过程中使用外科医生制作的妥布霉素-万古霉素PMMA板(PLATE)来预防感染。作者假设,与过去的做法相比,这种干预会减少感染:2021年,三家医疗机构的外科医生开始独立为初次TE乳房重建提供PLATE。在获得独立的IRB批准后,对PLATE受试者和干预前的同等规模队列进行了数据回顾性收集。对受试者进行了为期七个月的随访,或随访至第二阶段切除。主要结果,即需要再次入院/手术的并发症,在汇总队列之间进行比较。分析包括逻辑模型和 Kaplan-Meyer 生存率:总样本包括 183 名干预对象(292 个乳房)和 183 名对照对象(301 个乳房),每组的随访时间均为 5+/-2 个月。总体而言,PLATE 的并发症发生率明显较低(13.1% 对 21.9%,P0.05)。在多变量回归中,干预可显著降低任何并发症(OR=0.53,95%CI:[0.3-0.93])和感染(OR=0.22,95%CI:[0.08-0.50])的几率。Kaplan-Meyer曲线显示,并发症和感染的纵向发生率显著降低(pConclusion):在 TE 植入术中预防性使用术中制作的 PLATE 可显著减少感染,且不会增加局部或全身并发症。这种可重复的工具在异体乳房重建中可能非常有价值。
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来源期刊
CiteScore
5.00
自引率
13.90%
发文量
1436
审稿时长
1.5 months
期刊介绍: For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.
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