Rizik primjene aloplastičnih materijala kod primarne rekonstrukcije dojke

master's thesis

• Title (english): Risks associated with alloplastic material use in primary breast reconstruction
• Author: Ana-Marija Popović
• Mentor: Zdenko Stanec (mentor)
• Committee member: Rado Žic (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Zdenko Stanec (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Uvod i ciljevi: Upotreba aloplastičnih materijala za pokrivanje defekta donjeg pola dojke kod primarne rekonstrukcije pomoću implantata postala je sve raširenija alternativa kompletnoj rekonstrukciji autolognim tkivom. Obje vrste rekonstruktivnih zahvata nose rizik određenih ranih i kasnih komplikacija. Cilj ove studije bio je usporediti sigurnost primjene odnosno učestalost komplikacija između bolesnica kod kojih je primarna rekonstrukcija izvedena s potpunim pokrivanjem implantata autolognim tkivom i onih kod kojih su u rekonstrukciji korišteni aloplastični materijali. ----- Bolesnice i metodologija: Retrospektivna studija uključila je bolesnice operirane u razdoblju od 2012. do 2016. godine na Klinici za plastičnu, rekonstrukcijsku i estetsku kirurgiju Kliničke bolnice Dubrava, kod kojih je nakon mastektomije učinjena primarna rekonstrukcija dojke implantatom. Uključeno je ukupno 98 bolesnica s primarnom rekonstrukcijom 115 dojki, a kod 21 bolesnice, odnosno rekonstrukcije 26 dojki, korišten je aloplastični materijal. Uspoređena je među skupinama učestalost ranih i kasnih komplikacija, te potreba za kirurškom revizijom i ekstrakcijom proteze. ----- Rezultati: Ukupna učestalost ranih komplikacija iznosila je 44/115 (38.3%), od čega 9/26 (34.6%) u skupini s korištenjem aloplastičnih materijala i 35/89 (39.3%) u skupini s rekonstrukcijom autolognim tkivom. Učestalost pojedinačnih komplikacija također se nije značajno razlikovala među skupinama (serom 11.54% vs. 16.85%, hematom 3.85% vs. 3.37%, infekcija 11.54% vs. 11.24%, apsces 0 vs. 2.25%, MAK nekroza 0 vs. 3.37%, dehiscencija rane 0 vs. 1.12%, nekroza kožnog režnja 3.85% vs. 0%, protruzija implantata 3.85% vs. 1.12%). Učestalost kasnih komplikacija bila je učestalija u skupini s rekonstrukcijom autolognim tkivom: kontraktura fibrozne kapsule 14.6% vs. 3.8%, a ruptura implantata 3.37% vs. 0%. Potreba za kirurškom revizijom, odnosno ekstrakcijom implantata, bila je podjednaka u obje skupine (14.6% vs. 11.5%). ----- Zaključak: Primjena alopastičnih materijala kod rekonstrukcije donjeg pola dojke predstavlja sigurnu terapijsku opciju, sa stopama komplikacija koje su usporedive ili manje u odnosu na rekonstrukciju autolognim tkivom.

Abstract (english)

Introduction and aims: Alloplastic material use in primary breast reconstruction has become a widely-accepted alternative to traditional complete submuscular coverage. Both types of reconstruction procedures confer a certain risk for early and late complications. The aim of our study was to compare safety of these procedure types by analysis of complication rates. ----- Patients and methods: Retrospective study included patients operated in the period from 2012 to 2016 at Department of plastic, reconstructive and aesthetic surgery, University hospital Dubrava, who underwent implant-based primary breast reconstruction after mastectomy. We included 98 patients with primary reconstruction of 115 breasts, including 21 patients (26 breasts) with alloplastic material use. The groups were compared with regard to early and late complications, as well as need for surgical revision and implant removal. ----- Results: Early complications rate in our cohort was 44/115 (38.3%), including 9/26 (34.6%) in group with alloplastic material use and 35/89 (39.3%) in group with complete submuscular coverage. Frequency of specific complications was also similar between groups (seroma 11.54% vs. 16.85%, hematoma 3.85% vs. 3.37%, infection 11.54% vs. 11.24%, abscess 0 vs. 2.25%, NAC necrosis 0 vs. 3.37%, wound dehiscence 0 vs. 1.12%, flap necrosis 3.85% vs. 0%, implant protrusion 3.85% vs. 1.12%). Late complications were more frequent in traditional complete submuscular coverage group: capsular contraction 14.6% vs. 3.8%, and implant rupture 3.37% vs. 0%. Surgical revision and implant extraction frequency was similar in both groups (14.6% vs. 11.5%). ----- Conclusion: Alloplastic material use in primary breast reconstruction represents a safe therapeutic option, with complication rates that are similar or even lower when compared to reconstruction with traditional complete submuscular coverage.

• Keywords: uporaba aloplastičnih materijala; primarna rekonstrukcija dojke; rekonstrukcija dojke pomoću implantata; komplikacije; PTFE mrežica
• Keywords (english): alloplastic material use; primary breast reconstruction; implant-based breast reconstruction; complications; PTFE mesh
• Language: croatian
• URN:NBN: urn:nbn:hr:105:791163
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-03 10:56:06