Robertson Stuart A, Jeevaratnam Johann A, Agrawal Avi, Cutress Ramsey I
Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry.
Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth.
Breast Cancer (Dove Med Press). 2017 Mar 13;9:141-152. doi: 10.2147/BCTT.S81712. eCollection 2017.
Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%-30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions.
A MEDLINE search was performed using the search term "mastectomy skin flap necrosis". Titles and abstracts from peer-reviewed publications were screened for relevance.
MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited.
MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.
文献报道乳房切除术皮瓣坏死（MSFN）的发生率为5%-30%。它往往是一个严重且未得到充分重视的问题。本文旨在综述相关挑战及可能的解决方案。
使用检索词“乳房切除术皮瓣坏死”进行MEDLINE检索。对同行评审出版物的标题和摘要进行相关性筛选。
MSFN是一种常见并发症，可能表现为部分厚度或全层坏死。预测患者的风险因素包括吸烟、糖尿病、肥胖、放疗、既往瘢痕和严重的内科合并症。MSFN会带来诸多挑战，包括伤口处理问题、辅助治疗延迟、美观受损、植入物外露、患者痛苦和经济损失。术前仔细规划和细致的手术技术可降低MSFN的发生率。有多种术中技术可用于尝试预测有MSFN风险的皮瓣。MSFN可通过手术或非手术方式处理。早期干预可能会降低某些病例中MSFN的发病率。局部应用硝酸甘油软膏可能有助于减少即刻重建术后的MSFN，但证据基础仍然有限。
MSFN会给患者和医疗服务带来相当大的挑战。本综述讨论了该问题的处理选择。
