Use of a controlled negative pressure system for the treatment of periprosthetic breast complications

Abstract

Background. One of the most common methods of breast reconstruction after mastectomy for malignant tumors is reconstruction using an endoprosthesis. However, this technique is associated with the risk of developing periprosthetic complications. The classic solution to this problem is to remove the endoprosthesis, achieve complete remission of the infectious process and repeat the cycle of reconstructive measures. In this work we present a new approach to the treatment of periprosthetic complications.Aim. To evaluate the effectiveness of the controlled negative pressure system (CNP) in the treatment of periprosthetic breast complications.Materials and methods. From 2019 to 2023, the study included 23 patients who underwent combined/complex treatment for breast cancer, including reconstructive plastic surgery with the installation of endoprostheses, and 1 patient who underwent aesthetic surgery was included. All patients experienced various complications after the reconstructive stage: protrusion of the endoprosthesis, ischemia of the flap and/or local inflammation. To relieve the complications that arose, treatment was carried out using a flushing system and a CNP.Results. The duration of therapy with the sequential installation of a flushing system followed by replacement with a СNP averaged 15 days. In 7 cases out of 24, it was not possible to preserve or reinstall endoprostheses due to thinning of the musculocutaneous flap, resistance of the microflora to the treatment, or relapse of the infectious process. In 17 cases, no complications were recorded after re-installation of endoprostheses for 2 years. As a result of the work, in most cases, within one hospitalization, it was possible to preserve the skin sheath, achieve complete regression of complications and perform repeated reconstructive interventionConclusion. In most cases, the use of a CNP allows you to save the bed for the full installation of a new endoprosthesis. To do this, a number of conditions must be met: absence of microflora growth; presence of granulation after treatment; full thickness and integrity of the musculocutaneous flap. Systemic treatment and a history of radiation therapy are not a contraindication to retaining endoprostheses.

Keywords

• periprosthetic infection
• implant protrusion
• complications during breast reconstruction
• controlled negative pressure system
• negative pressure treatment