Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom.
J Plast Reconstr Aesthet Surg. 2013 Dec;66(12):1676-82. doi: 10.1016/j.bjps.2013.07.034. Epub 2013 Sep 4.
Experimental data has shown an association with a reduction of flap necrosis after local heat-application to a supraphysiological level resulting from the up-regulation of heat shock proteins, such as HSP-32. The proteins maintained capillary perfusion and increased tissue tolerance to ischaemia. The purpose of this translational study was to evaluate the effect of local heat preconditioning before skin sparing mastectomy and immediate breast reconstruction.
A prospective non-randomised trial was performed from July 2009-April 2010. 50 consecutive patients at risk of skin flap necrosis (BMI >30, sternal-to-nipple distance>26 cm or breast size>C-cup) were included. Twenty-five patients were asked to heat-precondition their breast 24-h prior to surgery using a hot water bottle with a water temperature of 43 °C (thermometers provided), in three 30-min cycles interrupted by spontaneous cooling to room temperature. Skin flap necrosis was defined by the need for surgical debridement. LDI images were taken pre- and post-mastectomy to demonstrate an increase in tissue vascularity.
36% of women (n=25) without local heat-treatment developed skin flap necrosis, 12% developed skin flap necrosis in the treatment group, resulting in a 24% difference (n=25; p=0.047 (95%CI 1%-47%)). LDI scanning of the heated breast demonstrated an increase in vascularity compared to the contralateral non-heated breast. Median length of inpatient stay for treatment group was 4 days (95%CI(4, 7)), controls 8 days (95%CI(8, 9) (p=<0.001)).
The data suggests that in selected cases, local heat preconditioning is a simple and non-invasive method of reducing skin necrosis and length of hospital stay following skin sparing mastectomy.
ACTRN12612001197820.
II.
实验数据表明，通过局部热疗将热休克蛋白（如 HSP-32）上调到超生理水平，可以减少皮瓣坏死。这些蛋白质维持毛细血管灌注并增加组织对缺血的耐受性。本转化研究的目的是评估在保留皮肤的乳房切除术和即刻乳房重建之前进行局部热预处理的效果。
2009 年 7 月至 2010 年 4 月进行了一项前瞻性非随机试验。纳入了 50 名有皮肤皮瓣坏死风险的连续患者（BMI>30、胸骨至乳头距离>26cm 或乳房大小>C 罩杯）。25 名患者被要求在手术前 24 小时使用 43°C 的热水瓶（提供温度计）对乳房进行热预处理，每次 30 分钟，中间自发冷却至室温，共进行三个周期。皮瓣坏死定义为需要手术清创。在乳房切除术前和术后进行 LDI 图像检查，以显示组织血管增加。
36%（n=25）未接受局部热治疗的女性发生了皮肤皮瓣坏死，治疗组有 12%（n=25）发生了皮肤皮瓣坏死，差异为 24%（n=25；p=0.047（95%CI 1%-47%））。加热乳房的 LDI 扫描显示与对侧未加热乳房相比，血管增加。治疗组的中位住院时间为 4 天（95%CI（4,7）），对照组为 8 天（95%CI（8,9）（p<0.001））。
数据表明，在选择的病例中，局部热预处理是一种简单且非侵入性的方法，可以减少保留皮肤的乳房切除术和皮瓣坏死以及住院时间。
ACTRN12612001197820。
II。
