Abstract:
BACKGROUND:Periprosthetic infections represent major complications in breast reconstruction, frequently leading to expander-implant loss. No consensus regarding a management algorithm for attempted salvage currently exists. This study assessed outcomes of the authors' salvage protocol using an antibiotic-impregnated polymethylmethacrylate implant with expander device exchange. METHODS:A retrospective chart review identified infected implant-based breast reconstruction cases treated between 2009 and 2017. Of 626 cases initially identified, a total of 62 cases had severe prosthetic infections, and underwent either prosthetic salvage (n = 45) or immediate explantation (n = 17). All the prosthetic salvage patients received intravenous antibiotics followed by surgical débridement, insertion of polymethylmethacrylate plates, device exchange, and postoperative antibiotics. After clinical resolution of infection, tissue expansion was performed, with the polymethylmethacrylate plates remaining in situ until exchanged for permanent implants. RESULTS:The authors' study demonstrated a primary infection clearance rate of 82.2 percent (n = 37). Compared to the traditional explantation group, a significantly higher percentage of the salvage patients completed final reconstruction (84.4 percent versus 35.3 percent; p < 0.001). Fewer patients abandoned reconstruction efforts after infection clearance (2.2 percent versus 58.8 percent; p < 0.001). The majority of cases (78.8 percent) that succeeded the salvage protocol ultimately received implant-based reconstruction; 62.5 percent that failed the salvage protocol still went on to receive autologous tissue reconstruction. CONCLUSIONS:Sustained local antibiotic delivery using polymethylmethacrylate implants and expander device exchange can successfully salvage an infected breast expander/implant. Compared with the traditional explantation approach, more patients complete final reconstruction. Other benefits include preserved skin envelope integrity and possibly improved long-term aesthetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Xue AS,Volk AS,DeGregorio VL,Jubbal KT,Bullocks JM,Izaddoost SAdoi
10.1097/PRS.0000000000006501subject
Has Abstractpub_date
2020-02-01 00:00:00pages
240e-250eissue
2eissn
0032-1052issn
1529-4242pii
00006534-202002000-00005journal_volume
145pub_type
杂志文章abstract:BACKGROUND:Adipose-derived stem cells and ceiling culture-derived preadipocytes can be harvested from subcutaneous adipose tissue. Little is known about the epigenetic differences, which may contribute to differences in osteogenic potential, between these cell types. The purpose of this study was to address the osteoge...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000005913
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Information about silicone gel implant longevity is sparse. Magnetic resonance imaging studies have superseded explantation studies in the search for data on their long-term integrity. Unfortunately, the majority of studies are based predominantly on second-generation implant cohorts. Although magnetic reson...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000279374.99503.89
更新日期:2007-10-01 00:00:00
abstract::In a randomized study, the effectiveness of double gloving in maintaining an intact barrier between the patient and the hands of the surgical staff during plastic surgery operations was tested. For 2 months, the surgical staff of a plastic surgery unit randomly wore single or double gloves during all elective surgical...
journal_title:Plastic and reconstructive surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00006534-199704000-00003
更新日期:1997-04-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to illustrate the morphologic changes of the mandible after outer cortex osteotomy. METHODS:Ten patients had undergone mandibular outer cortex osteotomy. By using the true-up and dissection techniques based on three-dimensional spiral computed tomography, variables of effect an...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181845951
更新日期:2008-10-01 00:00:00
abstract::In 37 cadavers of average age 75.5 years, the calvarium was studied. In all, the diploe and outer and inner tables were found to be definite layers. Although the parietal bone thickness did decrease with age in this study, there was no correlation between age and the outer table or diploe thickness. No significant cha...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198907000-00006
更新日期:1989-07-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine whether computer-morphed images convey realistic expectations of the postoperative cosmetic result to patients seeking rhinoplasty. METHODS:This was a retrospective study in which preoperative, computer-morphed, and 1-year postoperative images of 25 consecutive rhi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000254825.41066.f2
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:The rat model has had limited utility for the study of long nerve gaps because of the small size of the animal. The authors sought to develop a simple, effective rat model for reconstruction of long nerve gap defects. METHODS:Fifteen rats had a sciatic nerve transection followed by reconstruction. Positive ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e31829fe515
更新日期:2013-10-01 00:00:00
abstract::The application of distraction osteogenesis to craniofacial surgery has altered the approach and treatment of congenital and acquired craniofacial defects. Although the histologic and ultrastructural changes associated with distraction osteogenesis have been described extensively, relatively little is known about the ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199811000-00033
更新日期:1998-11-01 00:00:00
abstract::Fifty female face-lift patients were evaluated preoperatively with psychological tests and psychiatric interviews. Their postoperative psychological courses were studied for up to 6 months. Approximately 30% had postoperative depressive reactions. These reactions were primarily correlated with a preexisting, clinicall...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198004000-00007
更新日期:1980-04-01 00:00:00
abstract::Free-tissue transfer has emerged as the ideal way of reconstructing complex facial defects. Multifaceted free flaps are often needed, and we have developed a simple technique to determine both the volume of tissue required and the localization of the various epithelial surfaces, thereby simplifying these complex recon...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199402000-00008
更新日期:1994-02-01 00:00:00
abstract::A meniscus of serosanguineous fluid may persist for weeks at the inferior pole of the periprosthetic space after submuscular augmentation mammaplasty. Subsequent tissue accommodation may allow the prosthesis to become displaced into the space kept patent by the fluid meniscus. Implant malpositions of this etiology can...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199609001-00012
更新日期:1996-09-01 00:00:00
abstract::Pulp plasty is a simple procedure that is used to debulk the bulbous-appearing pulp of a transplanted digit after toe-to-hand transplantation. A retrospective review of the effect of pulp plasty on the appearance and function of the debulked digit was conducted of 82 digits on 51 patients. Pulp plasty was performed on...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199509000-00019
更新日期:1995-09-01 00:00:00
abstract::Real-time ultrasonography in pregnancy can accurately detect gestational age, position of the fetus, position of the placenta, sex of the fetus, and many congenital anomalies before birth. To date, however, there has been no report of detection of a cleft lip-palate deformity by ultrasound. Two cases, in approximately...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198112000-00002
更新日期:1981-12-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to evaluate the impact of insurance type on use of diagnostic testing, treatments, and the efficiency of care for patients with carpal tunnel syndrome. METHODS:The 2009 to 2013 Truven MarketScan Databases were used to identify adult patients with carpal tunnel syndrome. Insuran...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000002635
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:Wound complications after perineal and groin obliterative procedures are a significant cause of morbidity, particularly following chemoradiation therapy. Vertical and, increasingly, oblique rectus abdominis myocutaneous flaps have been used to fill potential dead space and bring healthy, vascularized tissue ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000324
更新日期:2014-08-01 00:00:00
abstract::Intraoperative photography has the potential to raise costs and introduce possible contamination but is essential for documentation in plastic surgery. The authors evaluate their use of a waterproof camera immersed in povidone-iodine for taking intraoperative photographs in an efficient manner. A waterproof camera is ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000005327
更新日期:2019-03-01 00:00:00
abstract::Successful reconstructive surgery with muscle flaps depends on adequate arterial supply and undisturbed venous drainage. Combining such surgery with reconstructive vascular surgery of a large-caliber vein that is responsible for the venous drainage of the flap poses an additional challenge--the repaired vein's suscept...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200102000-00032
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:Aesthetic facial contouring procedures, particularly forehead augmentation, continue to increase in popularity in the Asian population. However, there are very few reports in the literature specifically examining the long-term outcomes of forehead fat grafting. In the present study, the authors aimed to obje...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000006122
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Acute compartment syndrome of the hand is an emergency requiring prompt surgical decompression. This cadaveric study aims to identify the myofascial compartments of the hand by detailed dissection and direct visualization, to provide an accurate anatomical basis for surgical decompression. METHODS:Fourteen ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181956538
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:Negative-pressure wound therapy with instillation is increasingly utilized as an adjunct therapy for a wide variety of wounds. Despite its growing popularity, there is a paucity of evidence and lack of guidance to provide effective use of this therapy. METHODS:A panel of experts was convened to provide guid...
journal_title:Plastic and reconstructive surgery
pub_type: 共识发展会议,杂志文章
doi:10.1097/PRS.0b013e3182a80586
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:The maxillary artery is recognized as the main vascular supply of the facial bones; nonetheless, clinical evidence supports a codominant role for the facial artery. This study explores the extent of the facial skeleton within a facial allograft that can be harvested based on the facial artery. METHODS:Twent...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000111
更新日期:2014-05-01 00:00:00
abstract::Reconstruction of the upper aerodigestive tract with free jejunal flaps is now an accepted alternative to more conventional techniques. Success rates for microsurgical transfer approach 100 percent; however, complications following this technique are reported despite technical success, ischemia being implicated as an ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199407000-00019
更新日期:1994-07-01 00:00:00
abstract::I didactically compared the breast as a glandular cone with an envelope of skin and subcutaneous tissue. The aesthetic alterations of the breast are classified in four groups related to form, to volume, to grams, and to ptosis in centimeters. An imaginary plane that passes by the mammary sulcus (plane A) will determin...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199005000-00013
更新日期:1990-05-01 00:00:00
abstract::The surgical correction of vertical malpositions of the human eye has been made relatively safe and reliable by recent surgical techniques. The authors define this condition as vertical orbital dystopia and review the etiology of this deformity in 38 recent consecutive cases that were surgically treated at the Craniof...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1981-02-01 00:00:00
abstract:BACKGROUND:In the spring of 2000, the U.S. Food and Drug Administration issued a ban on the use of Betadine (povidone-iodine; Purdue Frederick, Stamford, Conn.) in association with saline breast implants, because data seemed to indicate a higher rate of implant deflation in association with Betadine. Betadine has been ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000251088.51675.a8
更新日期:2007-01-01 00:00:00
abstract::An approach for the correction of cryptotia using a superiorly based superficial mastoid fascial flap and a skin paddle is introduced. The buried portion of the auricle was exposed through an incision made along the upper part of the helix, followed by an appropriate correction of the deformed cartilage. Protrusion of...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200003000-00002
更新日期:2000-03-01 00:00:00
abstract::The efficacy of the carbon dioxide laser for skin deepithelialization in humans was initially demonstrated using reduction mammaplasty as a clinical model. Twenty-two additional successful cases including use of this technique as an adjunct for other flap transpositions and overgrafting of skin grafts are described. T...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198904000-00020
更新日期:1989-04-01 00:00:00
abstract::The effect of rapid versus slow tissue expansion on random-pattern skin-flap survival lengths was evaluated in two groups of pigs. Each group (group 1--slow; group 2--rapid) was further evaluated for the effect that delay (A), delay plus expansion (B), expansion only (C), and acute flap elevation (D) had on flap lengt...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199311000-00020
更新日期:1993-11-01 00:00:00
abstract:BACKGROUND:Among hundreds of pathophysiologic factors that impair healing of the diabetic foot, diminished perfusion and neovascularization are critical. This study aimed to show the effect of human adipose-derived stem cells on healing of ischemic wounds in diabetic nude mice and thus to estimate the possibilities of ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e31821e6de2
更新日期:2011-08-01 00:00:00
abstract::Three patients requested explantation of their saline-filled breast implants. Bilateral calcification had occurred in all six implants. Four of the implants were manufactured by McGhan Corporation (Santa Barbara, Calif.), and two, by the Simaplast Company (Toulon, France). All implants had been inserted in the subglan...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200102000-00010
更新日期:2001-02-01 00:00:00