Greenhowe Jennifer, Stephen Christopher, McClymont Liusaidh, Munnoch D Alex
Department of Plastic Surgery, Ninewells Hospital and Medical School, Dundee, United Kingdom.
Department of Plastic Surgery, Ninewells Hospital and Medical School, Dundee, United Kingdom.
Breast. 2017 Aug;34:73-76. doi: 10.1016/j.breast.2017.05.002. Epub 2017 May 17.
Breast oedema causes significant morbidity and is historically difficult to quantify. The aim of this study was to identify changes in breast tissue water content from pre-operative levels in the native breast to post-operative levels in mastectomy skin flaps and free flaps in the reconstructed breast.
One hundred patients undergoing unilateral mastectomy and immediate free flap breast reconstruction were examined pre-operatively and at three post-operative appointments. A validated moisture meter was used to record dermal water percentages of each breast quadrant and areola in both breasts pre-operatively, then four quadrants of both breasts plus the unaffected areola and free flap at each post-operative review.
Native skin of the reconstructed breast showed significant, persistent increase in MWC from 45.6% ± 0.5% to 72.8% ± 0.9% at 1st follow up (p < 0.001), decreasing only to 67.6% ± 0.8% by 3rd follow up. There was a marked difference (p < 0.001) in the mean water content (MWC) of the initial free flap (39.7% ± 0.6%) compared to 61.8% ± 1.7% at 1st follow up, then 55.1% ± 1.4% at 2nd and 53.7% ± 1.3% at 3rd follow ups. The unaffected breast showed a small but significant increase in MWC of all quadrants at subsequent follow up (greatest difference 3.1% at 1st follow up). This patient group demonstrates significant, persistent oedema of the reconstructed breast, which can be monitored using a non-invasive moisture meter.
乳腺水肿会导致严重的发病率，并且长期以来难以量化。本研究的目的是确定乳腺组织含水量从术前天然乳房的水平到术后乳房切除皮瓣和重建乳房游离皮瓣的水平的变化。
对100例行单侧乳房切除及即刻游离皮瓣乳房重建的患者在术前及术后三次随访时进行检查。使用经过验证的水分仪记录术前双侧乳房每个象限及乳晕的皮肤水分百分比，然后在每次术后复查时记录双侧乳房的四个象限、未受影响的乳晕及游离皮瓣的水分百分比。
重建乳房的天然皮肤在第一次随访时平均含水量（MWC）从45.6%±0.5%显著持续增加至72.8%±0.9%（p<0.001），到第三次随访时仅降至67.6%±0.8%。初始游离皮瓣的平均含水量（MWC）为39.7%±0.6%，与第一次随访时的61.8%±1.7%相比有显著差异（p<0.001），第二次随访时为55.1%±1.4%，第三次随访时为53.7%±1.3%。未受影响的乳房在随后的随访中所有象限的MWC有小幅但显著的增加（第一次随访时最大差异为3.1%）。该患者组显示重建乳房存在显著的持续性水肿，可使用非侵入性水分仪进行监测。
