Atalay Can, Yilmaz Kerim Bora
Department of General Surgery, Ankara Oncology Hospital, Ankara, Turkey.
Breast Cancer Res Treat. 2009 Oct;117(3):611-4. doi: 10.1007/s10549-009-0335-z. Epub 2009 Feb 15.
Transcutaneous electrical nerve stimulation (TENS) is primarily used for pain reduction and is thought to activate neural fibers modifying vascular resistance and local blood flow influencing flap necrosis. This study aimed to delineate the effects of TENS on the viability of skin flaps created during mastectomy in breast cancer patients. Patients treated with modified radical mastectomy were prospectively randomized to receive either TENS or no further local treatment postoperatively. High frequency (70 Hz) and low intensity (2 mA) TENS was applied and areas of flap ecchymosis and necrosis were measured after the completion of TENS application and compared between the two groups. Patients were also compared according to age, comorbid diseases, duration of anesthesia, flap area, amount of wound drainage and seroma, presence of wound infection and abscess. In addition, local and systemic complications related to TENS were recorded. About 173 patients with a median age of 49 (range 25-87) were included in the study. About 87 patients received TENS whereas 86 patients formed the control group. Patients' characteristics were comparable between the two groups. Number of patients with skin flap necrosis was higher in the control group compared to TENS group (P < 0.0001). Mean area of flap necrosis was significantly lower in TENS group (85.2 +/- 35.9) compared to control group (252.5 +/- 64.1; P = 0.024). Similarly, number of patients with skin flap ecchymosis was higher in the control group compared to TENS group (P = 0.002). However, although mean area of flap ecchymosis was lower in TENS group (105.5 +/- 49.8) compared to control group (172.9 +/- 49.9), this difference did not reach statistical significance (P = 0.34). In addition, there were no local or systemic complications related to TENS application in patients. TENS can be safely used to decrease the amount of skin flap necrosis after mastectomy in breast cancer patients without any additional complication.
经皮电刺激神经疗法（TENS）主要用于减轻疼痛，被认为可激活神经纤维，改变血管阻力并影响局部血流，进而影响皮瓣坏死。本研究旨在阐明TENS对乳腺癌患者乳房切除术中所造皮瓣存活能力的影响。接受改良根治性乳房切除术的患者被前瞻性随机分组，术后分别接受TENS治疗或不进行进一步局部治疗。采用高频（70赫兹）和低强度（2毫安）的TENS治疗，在TENS治疗结束后测量皮瓣瘀斑和坏死面积，并在两组之间进行比较。还根据年龄、合并疾病、麻醉持续时间、皮瓣面积、伤口引流量和血清肿量、伤口感染和脓肿的存在情况对患者进行比较。此外，记录与TENS相关的局部和全身并发症。该研究纳入了约173例患者，中位年龄为49岁（范围25 - 87岁）。约87例患者接受了TENS治疗，而86例患者组成了对照组。两组患者的特征具有可比性。与TENS组相比，对照组皮瓣坏死患者数量更高（P < 0.0001）。TENS组皮瓣坏死的平均面积（85.2 +/- 35.9）明显低于对照组（252.5 +/- 64.1；P = 0.024）。同样，与TENS组相比，对照组皮瓣瘀斑患者数量更高（P = 0.002）。然而，尽管TENS组皮瓣瘀斑的平均面积（105.5 +/- 49.8）低于对照组（172.9 +/- 49.9），但这种差异未达到统计学意义（P = 0.34）。此外，患者中未出现与TENS应用相关的局部或全身并发症。TENS可安全用于减少乳腺癌患者乳房切除术后皮瓣坏死量，且无任何额外并发症。
