From the University of Colorado School of Medicine; and the Division of Plastic and Reconstructive Surgery, University of Colorado, Anschutz Medical Center.
Plast Reconstr Surg. 2020 Feb;145(2):459-467. doi: 10.1097/PRS.0000000000006438.
Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient.
The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection.
One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema.
Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.
上肢淋巴系统因癌症而受伤可能需要采取措施预防继发性淋巴水肿。指南已经制定，涉及止血带和选择性手部和上肢手术的使用。然而，手部手术的报告表明，先前的指南可能对患者没有保护作用。
本研究系统地回顾了评估乳腺癌患者选择性手部手术的当前文献。作者评估了并发症的风险，包括新的或恶化的淋巴水肿和感染。
确定了 198 篇摘要，并进行了文献回顾。有 9 项研究涉及我们的主题，其中 4 项被纳入最终审查。所有研究均包括先前接受过乳腺癌治疗，包括乳房手术和腋窝淋巴结清扫术的患者。几乎所有手术都使用了气压止血带。没有术前同侧淋巴水肿的患者发生新的淋巴水肿的发生率为 2.7％，术后感染的发生率为 0.7％。有术前淋巴水肿的患者，淋巴水肿恶化的发生率为 11.1％，感染的发生率为 16.7％。但是，所有新的或加重的淋巴水肿均在 3 个月内得到缓解。未发现止血带的使用会增加淋巴水肿的发生率。
根据现有证据，对于先前接受过乳腺癌治疗的患者进行选择性手部手术，并发症的风险没有增加。先前存在同侧淋巴水肿的乳腺癌患者术后感染和淋巴水肿恶化的风险略有增加。作者认为并建议，在先前接受过乳腺癌治疗的患者中，使用止血带进行选择性手部手术并不是矛盾的。
