Archives of Plastic Surgery

  • 제46권6호
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  • Pages.544-549
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  • 2019
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Inlay graft of acellular dermal matrix to prevent incisional dehiscence after radiotherapy in prosthetic breast reconstruction

  • Kim, Mi Jung (Department of Plastic and Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Ahn, Sung Jae (Department of Plastic and Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Fan, Kenneth L. (Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital) ;
  • Song, Seung Yong (Department of Plastic and Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Lew, Dae Hyun (Department of Plastic and Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine) ;
  • Lee, Dong Won (Department of Plastic and Reconstructive Surgery and Institute for Human Tissue Restoration, Yonsei University College of Medicine)
  • 투고 : 2018.01.24
  • 심사 : 2019.09.01
  • 발행 : 2019.11.15
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초록

Background As the indications for postmastectomy radiotherapy expand, innovative solutions are required to reduce operative complications and reconstructive failure after prosthetic breast reconstruction. In this study, we investigated the effectiveness of acellular dermal matrix (ADM) inlay grafts in preventing postoperative wound dehiscence of irradiated breasts in the context of prosthetic breast reconstruction. Methods A retrospective analysis was conducted of 45 patients who received two-stage prosthetic reconstruction and radiotherapy following mastectomy. An ADM graft was placed beneath the incisional site during the second-stage operation in 19 patients using marionette sutures, whereas the control group did not receive the ADM reinforcement. Patient demographics and complications such as wound dehiscence, capsular contracture, peri-prosthetic infection, cellulitis, and seroma were compared between the two groups. Results During an average follow-up period of 37.1 months, wound dehiscence occurred significantly less often in the ADM-reinforced closure group (0%) than in the non-ADM group (23.1%) (P=0.032). There was no significant difference between the two groups in relation to other complications, such as capsular contracture, postoperative infection, or seroma. Conclusions The ADM inlay graft is a simple and easily reproducible technique for preventing incisional dehiscence in the setting of radiotherapy after prosthetic breast reconstruction. The ADM graft serves as a buttress to offload tension during healing and provides a mechanical barrier against pathogens. Application of this technique may serve to reduce complications in prosthetic breast reconstruction after radiotherapy.

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참고문헌

  1. Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 2011;22:1736-47. https://doi.org/10.1093/annonc/mdr304
  2. Budach W, Bolke E, Kammers K, et al. Adjuvant radiation therapy of regional lymph nodes in breast cancer: a meta-analysis of randomized trials-an update. Radiat Oncol 2015; 10:258. https://doi.org/10.1186/s13014-015-0568-4
  3. Jagsi R, Momoh AO, Qi J, et al. Impact of radiotherapy on complications and patient-reported outcomes after breast reconstruction. J Natl Cancer Inst 2018;110:157-65. https://doi.org/10.1093/jnci/djx148
  4. Elder EE, Brandberg Y, Bjorklund T, et al. Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast 2005;14:201-8. https://doi.org/10.1016/j.breast.2004.10.008
  5. Krueger EA, Wilkins EG, Strawderman M, et al. Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 2001;49:713-21. https://doi.org/10.1016/S0360-3016(00)01402-4
  6. Lin KY, Blechman AB, Brenin DR. Implant-based, two-stage breast reconstruction in the setting of radiation injury: an outcome study. Plast Reconstr Surg 2012;129:817-23. https://doi.org/10.1097/PRS.0b013e31824421d0
  7. Nahabedian MY. AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. Plast Reconstr Surg 2009;124:1743-53. https://doi.org/10.1097/PRS.0b013e3181bf8087
  8. Nava MB, Pennati AE, Lozza L, et al. Outcome of different timings of radiotherapy in implant-based breast reconstructions. Plast Reconstr Surg 2011;128:353-9. https://doi.org/10.1097/PRS.0b013e31821e6c10
  9. Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg 2013;131:15-23. https://doi.org/10.1097/PRS.0b013e3182729cde
  10. Park EH, Min SY, Kim Z, et al. Basic facts of breast cancer in Korea in 2014: the 10-year overall survival progress. J Breast Cancer 2017;20:1-11. https://doi.org/10.4048/jbc.2017.20.1.1
  11. Chun YS, Verma K, Rosen H, et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg 2010;125: 429-36. https://doi.org/10.1097/PRS.0b013e3181c82d90
  12. JoAnna Nguyen T, Carey JN, Wong AK. Use of human acellular dermal matrix in implant- based breast reconstruction: evaluating the evidence. J Plast Reconstr Aesthet Surg 2011; 64:1553-61. https://doi.org/10.1016/j.bjps.2011.02.001
  13. Clemens MW, Kronowitz SJ. Acellular dermal matrix in irradiated tissue expander/implant-based breast reconstruction: evidence-based review. Plast Reconstr Surg 2012;130 (5 Suppl 2):27S-34S. https://doi.org/10.1097/PRS.0b013e318265f690
  14. Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: current issues. Plast Reconstr Surg 2004;114:950-60. https://doi.org/10.1097/01.PRS.0000133200.99826.7F
  15. Spear SL, Baker JL Jr. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 1995;96:1119-23. https://doi.org/10.1097/00006534-199510000-00018
  16. McCarthy CM, Klassen AF, Cano SJ, et al. Patient satisfaction with postmastectomy breast reconstruction: a comparison of saline and silicone implants. Cancer 2010;116:5584-91. https://doi.org/10.1002/cncr.25552
  17. Spear SL, Shuck J, Hannan L, et al. Evaluating long-term outcomes following nipple-sparing mastectomy and reconstruction in the irradiated breast. Plast Reconstr Surg 2014; 133:605e-614e. https://doi.org/10.1097/01.prs.0000438463.90968.d6
  18. Sbitany H, Wang F, Peled AW, et al. Immediate implant-based breast reconstruction following total skin-sparing mastectomy: defining the risk of preoperative and postoperative radiation therapy for surgical outcomes. Plast Reconstr Surg 2014;134:396-404. https://doi.org/10.1097/PRS.0000000000000466
  19. Pestana IA, Campbell DC, Bharti G, et al. Factors affecting complications in radiated breast reconstruction. Ann Plast Surg 2013;70:542-5. https://doi.org/10.1097/SAP.0b013e31827eacff
  20. Nahabedian MY. Minimizing incisional dehiscence following 2-stage prosthetic breast reconstruction in the setting of radiation therapy. Gland Surg 2013;2:133-6.
  21. Delanian S, Lefaix JL. The radiation-induced fibroatrophic process: therapeutic perspective via the antioxidant pathway. Radiother Oncol 2004;73:119-31. https://doi.org/10.1016/j.radonc.2004.08.021
  22. Mikkelsen RB, Wardman P. Biological chemistry of reactive oxygen and nitrogen and radiation-induced signal transduction mechanisms. Oncogene 2003;22:5734-54. https://doi.org/10.1038/sj.onc.1206663
  23. Cordeiro PG, Albornoz CR, McCormick B, et al. What is the optimum timing of postmastectomy radiotherapy in two-stage prosthetic reconstruction: radiation to the tissue expander or permanent implant? Plast Reconstr Surg 2015; 135:1509-17. https://doi.org/10.1097/PRS.0000000000001278
  24. Branch JP. A tendon graft weave using an acellular dermal matrix for repair of the Achilles tendon and other foot and ankle tendons. J Foot Ankle Surg 2011;50:257-65. https://doi.org/10.1053/j.jfas.2010.12.015
  25. Brigido SA. The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot study. Int Wound J 2006;3:181-7. https://doi.org/10.1111/j.1742-481X.2006.00209.x

피인용 문헌

  1. Hypofractionated Radiotherapy With Volumetric Modulated Arc Therapy Decreases Postoperative Complications in Prosthetic Breast Reconstructions: A Clinicopathologic Study vol.10, 2019, https://doi.org/10.3389/fonc.2020.577136
  2. Use of a Bioabsorbable Implant-Acellular Dermal Matrix Construct to Facilitate Oncoplastic Breast-conserving Surgery vol.9, pp.1, 2021, https://doi.org/10.1097/gox.0000000000003356