Vargas Christina R, Koolen Pieter G, Anderson Katarina E, Paul Marek A, Tobias Adam M, Lin Samuel J, Lee Bernard T
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2015 Oct;198(2):530-4. doi: 10.1016/j.jss.2015.03.076. Epub 2015 Apr 1.
Mastectomy skin necrosis represents a significant clinical morbidity after immediate breast reconstruction. In addition to aesthetic deformity, necrosis of the native mastectomy skin may require debridement, additional reconstruction, or prolonged wound care and potentially delay oncologic treatment. This study aims to evaluate patient and procedural characteristics to identify predictors of mastectomy skin necrosis after microsurgical breast reconstruction.
A retrospective review was performed of all immediate microsurgical breast reconstructions performed at a single academic center. Patient records were queried for age, diabetes, active smoking, previous breast surgery, preoperative radiation, preoperative chemotherapy, body mass index, mastectomy type, mastectomy weight, flap type, autologous flap type, and postoperative mastectomy skin flap necrosis.
There were 746 immediate autologous microsurgical flaps performed by three plastic surgeons at our institution during the study period. The incidence of mastectomy skin flap necrosis was 13.4%. Univariate analysis revealed a significantly higher incidence of mastectomy skin necrosis in patients with higher mastectomy weight (P < 0.001), higher autologous flap weight (P < 0.001), higher body mass index (0.002), and diabetes (P = 0.021). No significant association was found for age, smoking, prior breast surgery, preoperative chemotherapy or radiation, or mastectomy type. Multivariate analysis demonstrated statistically significant associations between mastectomy skin necrosis and both increasing mastectomy weight (odds ratio 1.348 per quartile increase, P = 0.009) and diabetes (odds ratio 2.356, P = 0.011).
Increasing mastectomy weight and coexisting diabetes are significantly associated with postoperative mastectomy skin necrosis after microsurgical reconstruction. These characteristics should be considered during patient counseling, procedure selection, operative planning, and intraoperative tissue viability assessment.
乳房切除术后皮瓣坏死是即刻乳房重建术后一种严重的临床并发症。除了美观畸形外，乳房切除术后皮瓣坏死可能需要清创、额外的重建手术，或延长伤口护理时间，并可能延迟肿瘤治疗。本研究旨在评估患者及手术相关特征，以确定显微外科乳房重建术后乳房切除术后皮瓣坏死的预测因素。
对在单一学术中心进行的所有即刻显微外科乳房重建手术进行回顾性研究。查询患者记录，了解其年龄、糖尿病史、当前吸烟情况、既往乳房手术史、术前放疗、术前化疗、体重指数、乳房切除术类型、乳房切除重量、皮瓣类型、自体皮瓣类型以及术后乳房切除皮瓣坏死情况。
在研究期间，我们机构的三位整形外科医生共进行了746例即刻自体显微外科皮瓣手术。乳房切除皮瓣坏死的发生率为13.4%。单因素分析显示，乳房切除重量较大（P < 0.001）、自体皮瓣重量较大（P < 0.001）、体重指数较高（P = 0.002）以及患有糖尿病（P = 0.021）的患者，乳房切除术后皮瓣坏死的发生率显著更高。未发现年龄、吸烟、既往乳房手术、术前化疗或放疗以及乳房切除术类型之间存在显著关联。多因素分析表明，乳房切除术后皮瓣坏死与乳房切除重量增加（每增加一个四分位数，优势比为1.348，P = 0.009）和糖尿病（优势比为2.356，P = 0.011）均存在显著统计学关联。
乳房切除重量增加和并存糖尿病与显微外科重建术后乳房切除术后皮瓣坏死显著相关。在患者咨询、手术选择、手术规划以及术中组织活力评估过程中，应考虑这些特征。
