{"id":16813,"date":"2024-05-10T06:48:38","date_gmt":"2024-05-10T06:48:38","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=16813"},"modified":"2024-05-16T12:13:19","modified_gmt":"2024-05-16T12:13:19","slug":"llr-policy-for-the-use-of-surgical-biological-mesh","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/ro\/llr-policy-for-the-use-of-surgical-biological-mesh\/","title":{"rendered":"Politica LLR pentru utilizarea plaselor biologice chirurgicale"},"content":{"rendered":"

Categoria<\/strong><\/p>\n\n\n\n

Criterii de prag<\/p>\n\n\n\n

Matricele dermice acelulare este un dispozitiv medical consacrat utilizat pentru o varietate de interven\u021bii chirurgicale \u00een Marea Britanie, cu rezultate \u00eembun\u0103t\u0103\u021bite pentru pacien\u021bi. Exist\u0103 un num\u0103r semnificativ de dovezi c\u0103 re\u021belele biologice pot \u00eembun\u0103t\u0103\u021bi semnificativ rezultatele estetice \u0219i pot extinde indica\u021biile pentru reconstruc\u021bia s\u00e2nilor \u0219i pot duce la o contrac\u021bie capsular\u0103 mai mare \u0219i redus\u0103 \u0219i o mai mare satisfac\u021bie a pacientului dup\u0103 opera\u021bie.<\/p>\n\n\n\n

Eligibilitate<\/strong><\/p>\n\n\n\n

LLR ICB va fi finan\u021bat numai atunci c\u00e2nd sunt \u00eendeplinite urm\u0103toarele criterii pentru CHIRURGIA DE RECONSTRUC\u021aIE MAMAR\u0102<\/strong>
\u00a0<\/strong>
\u2013 Pacien\u021bi cu cancer de s\u00e2n, carcinom ductal insitu \u0219i cei care sunt identifica\u021bi ca av\u00e2nd gene cu risc ridicat, de exemplu BRCA 1\/2, TP53, PTEN
\u0218I<\/strong>
\u2013 Pacientul are \u00eenveli\u0219 cutanat adecvat pentru a reduce riscul de necroz\u0103 a pielii
\u00a0
Auditul regulat al pacien\u021bilor supu\u0219i reconstruc\u021biei mamare cu utilizarea plasei biologice, a\u0219a cum este recomandat de ghidurile comune ale ABS \u0219i BAPRAS. Cerin\u021ba absolut\u0103 este pierderea implantului <10%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
LLR ICB NU va finan\u021ba utilizarea plasei biologice la urm\u0103torii pacien\u021bi<\/strong>
\u00a0<\/strong>
\u2013 Pacien\u021bi care au avut anterior radioterapie toracic\u0103
\u2013 Pacien\u021bi care fumeaz\u0103 \u00een prezent<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
ICB recomand\u0103 pruden\u021b\u0103 \u00een urm\u0103toarele situa\u021bii<\/strong>
\u00a0<\/strong>
- Pacien\u021bi cu un IMC > 30
\u2013 Dimensiunea s\u00e2nilor mai mare de 600 mg (risc crescut de infec\u021bie)
\u2013 Pacien\u021bi cu diabet zaharat slab controlat<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
LLR ICB va fi finan\u021bat numai atunci c\u00e2nd urm\u0103toarele criterii sunt \u00eendeplinite pentru REPARAREA HERNIEI PARAOESOFAGIENE<\/strong>
\u00a0<\/strong>
Pacientul are goluri mari \u00een diafragm\u0103 care nu pot fi reparate chirurgicale simple<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Mesh Biologic NU este comandat pentru<\/strong>
\u2013 Chirurgie toracic\u0103
\u2013 APER\/ eLAPE
\u2013 Repararea herniei, altele dec\u00e2t cele de mai sus
\u2013 Orice alte indica\u021bii<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

\u00cendrumare<\/strong><\/p>\n\n\n\n

\u00a0
\u2013 Evaluarea eficacit\u0103\u021bii matricei dermice acelulare \u00een reconstruc\u021bia s\u00e2nilor pe baz\u0103 de protez\u0103
Plast Reconstr Surg . 2018 Mar;141(3):541-549. doi: 10.1097\/PRS.0000000000004109.
\u00a0
\u2013 Matricea dermic\u0103 acelular\u0103 bovin\u0103 \u00een reconstruc\u021bia imediat\u0103 a s\u00e2nilor: un studiu retrospectiv, observa\u021bional cu SurgiMend
Plast Reconstr Surg . 2018 ian;141(1):1e-10e. doi: 10.1097\/PRS.0000000000003982
\u00a0
\u2013 Matrice dermic\u0103 acelular\u0103 \u00een reconstruc\u021bia s\u00e2nilor: date privind rezultatele testului CARE pe 5 ani pentru mai mult de 9500 de pacien\u021bi
Plast Reconstr Surg Glob Open. 2022 Apr 14;10(4):e4258.
doi: 10.1097\/GOX.0000000000004258. eCollection 2022 apr.
\u00a0
\u2013 Nou\u0103 matrice derm\u0103 acelular\u0103 tridimensional\u0103 pentru reconstruc\u021bia prepectoral\u0103 a s\u00e2nilor: primul an \u00een revizuire cu BRAXON\u00ae Fast
Surg frontal. 2022 septembrie 5:9:970053. doi: 10.3389\/fsurg.2022.970053. eColectie 2022.
\u00a0
\u2013 Reconstruc\u021bie protetic\u0103 a s\u00e2nilor asistat\u0103 de derm\u0103 acelular\u0103: o revizuire sistematic\u0103 \u0219i critic\u0103 a eficacit\u0103\u021bii \u0219i a morbidit\u0103\u021bii asociate
Plast Reconstr Surg. 2011 Dec;128(6):1162-1169. doi: 10.1097\/PRS.0b013e318230c29e.
\u00a0
\u2013 Profil de siguran\u021b\u0103 \u0219i predictori ai rezultatelor estetice dup\u0103 reconstruc\u021bia prepectoral\u0103 a s\u00e2nilor cu matrice derm\u0103 acelular\u0103 plasat\u0103
Ann Plast Surg. 2021 iunie 1;86(6S Suppl 5):S585-S592. doi: 10.1097\/SAP.0000000000002764.
\u00a0
\u2013 Reconstruc\u021bie imediat\u0103 a s\u00e2nului direct la implant cu matrice derm\u0103 acelular\u0103: Evaluarea complica\u021biilor \u0219i siguran\u021bei
S\u00e2nul. Decembrie 2021:60:192-198. doi: 10.1016\/j.breast.2021.10.006. Epub 2021 15 octombrie.
\u00a0
\u2013 Matrice dermic\u0103 acelular\u0103 ca adjuvant al reconstruc\u021biei mamare cu implant: Analiza rezultatelor \u0219i complica\u021biilor
Eur J Surg Oncol. 2020 Apr;46(4 Pt A):511-515. doi: 10.1016\/j.ejso.2019.10.042. Epub 2019 1 noiembrie.
\u00a0
\u2013 Dovezi actualizate privind utilizarea matricei dermice acelulare pentru reconstruc\u021bia s\u00e2nilor pe baz\u0103 de implant: o meta-analiz\u0103
Ann Surg Oncol. 2016 Feb;23(2):600-10. doi: 10.1245\/s10434-015-4873-9.
\u00a0
\u2013 Reconstruc\u021bie prepectoral\u0103 direct\u0103 la implant \u00eentr-o singur\u0103 etap\u0103 cu ADM: siguran\u021b\u0103 \u0219i rezultat la \u201epacien\u021bii sub\u021biri\u201d
Clin Cancerul de San. 2023 Dec;23(8):e507-e514. doi: 10.1016\/j.clbc.2023.08.007. Epub 2023 25 august.
\u00a0
\u2013 Reconstruc\u021bie pre-pectoral\u0103 a s\u00e2nilor cu expansor tisular acoperit \u00een \u00eentregime de matrice dermic\u0103 acelular\u0103: fezabilitate, siguran\u021b\u0103 \u0219i caracteristici histologice rezultate din primele 64 de proceduri
Gland Surg. 27 martie 2024;13(3):297-306. doi: 10.21037\/gs-23-432. Epub 2024 22 martie.

\u2013 Mavros, M., Athanasiou, S., Alexiou, V., Mitsikostas, P., Peppas, G. \u0219i Falagas, M (2011) Risk Factors for Mesh-related Infections After Hernia Repair Surgery: A Meta-analysis of Cohort studii, Jurnalul Mondial de Chirurgie<\/em>, Vol. 11, pp. 2389-2398.
\u00a0<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Data revizuirii ARP 90: 2027<\/td><\/tr><\/tbody><\/table><\/figure>","protected":false},"excerpt":{"rendered":"

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