Gravante G, Araco A, Sorge R, Caruso R, Nicoli F, Araco F, Delogu D, Cervelli V
Department of General Surgery, Plastic Surgery and Laboratory of Biometry, University of Tor Vergata in Rome, Rome, Italy.
Aesthetic Plast Surg. 2008 Jan;32(1):25-31. doi: 10.1007/s00266-007-9048-z.
This prospective study followed patients who underwent breast reductions to determine the influence of smoking and the amount of tissue removed on postoperative wound infections.
Patients who had received breast reductions were considered eligible for the study. The study excluded postbariatric patients and those with ongoing clinical infections, a recent antibiotic course, or systemic diseases that could impair tissue oxygenation. Smokers were instructed to quit smoking at least 4 weeks before surgery.
By March 2004, the study had enrolled 87 patients. Postoperative infections were present in 24 cases (27.9%). Infections included 16 in smokers (37.2%), 8 in nonsmokers (18.2%; p < 0.05), 14 in patients with large resections (>0.85 kg; 70%), and 10 in patients with small resections (14.9%; p < 0.001). Significant differences were found between the patients who experienced infections and those who were infection free in terms of the overall estimated cigarettes smoked (mean, 146,000; range, 29,200-228,125 vs mean, 10,950; range, 9,125-54,750; p < 0.001), the number of pack years (mean, 20; range, 4-31 vs mean, 2; range, 1-8; p < 0.001), and the amount of tissue removed (mean, 0.9 kg; range, 0.5-2 kg vs mean, 0.5 kg; range, 0.2-1.4 kg; p < 0.001). The analysis for all the patients determined an odds ratio of 2.04 for smoking and 4.7 for the amount of tissue removed.
Smoking and the amount of tissue removed are important issues in aesthetic breast surgery that need to be addressed accurately by the plastic surgeon. If future larger studies confirm these data, surgeons could have a simple and easy method for stratifying patients according to their risk for the development of wound infections and for prescribing specific preventive measures.
这项前瞻性研究对接受乳房缩小术的患者进行随访，以确定吸烟和切除组织量对术后伤口感染的影响。
接受乳房缩小术的患者被认为符合该研究条件。该研究排除了减肥术后患者以及那些有正在进行的临床感染、近期使用过抗生素疗程或患有可能损害组织氧合的全身性疾病的患者。吸烟者被要求在手术前至少4周戒烟。
到2004年3月，该研究共纳入87例患者。术后感染24例（27.9%）。感染患者中吸烟者16例（37.2%），非吸烟者8例（18.2%；p<0.05）；切除组织量大（>0.85千克）的患者14例（70%），切除组织量小的患者10例（14.9%；p<0.001）。在总体估计吸烟量（平均146,000支；范围29,200 - 228,125支 vs 平均10,950支；范围9,125 - 54,750支；p<0.001）、包年数（平均20；范围4 - 31 vs 平均2；范围1 - 8；p<0.001）以及切除组织量（平均0.9千克；范围0.5 - 2千克 vs 平均0.5千克；范围0.2 - 1.4千克；p<0.001）方面，感染患者与未感染患者之间存在显著差异。对所有患者的分析确定吸烟的优势比为2.04，切除组织量的优势比为4.7。
吸烟和切除组织量是美容乳房手术中的重要问题，整形外科医生需要准确应对。如果未来更大规模的研究证实这些数据，外科医生可能会有一种简单易行的方法，根据患者发生伤口感染的风险对其进行分层，并制定具体的预防措施。
