Da Vinci Clinic, Geldrop, the Netherlands.
Corresponding author: Dr Nicole E Spruijt, Da Vinci Clinic, Nieuwendijk 49, 5664HB Geldrop, the Netherlands,
Diving Hyperb Med. 2021 Mar 31;51(1):2-9. doi: 10.28920/dhm51.1.2-9.
Hyperbaric oxygen treatment (HBOT) has been suggested as an effective intervention to limit necrosis of ischaemic skin flaps after mastectomy. The purpose of this study was to evaluate outcomes of HBOT in the largest series of patients to date with mastectomy flap ischaemia.
A retrospective analysis was performed of 50 breasts requiring HBOT for mastectomy flap ischaemia. The severity of the ischaemia or necrosis was evaluated by four independent observers using the skin ischaemia necrosis (SKIN) score. Multivariate logistic regression analyses were used to assess associations between risk factors and re-operation.
HBOT was started a median of 3 days (range 1-23) after surgery and continued for a median of 12 sessions (range 6-22). The breast SKIN surface area scores (n = 175 observations by the independent observers) improved in 34% (of observations) and the depth scores deteriorated in 42% (both P < 0.01). Both the surface area and depth scores were associated with the need for re-operation: higher scores, reflecting more severe necrosis of the mastectomy flap, were associated with increased need for re-operation. Twenty-nine breasts (58%) recovered without additional operation. Pre-operative radiotherapy (OR 7.2, 95% CI 1.4-37.3) and postoperative infection (OR 15.4, 95% CI 2.6-89.7) were risk factors for re-operation in multivariate analyses.
In this case series, the surface area of the breast affected by ischaemia decreased during HBOT, and most breasts (58%) did not undergo an additional operation. A randomised control trial is needed to confirm or refute the possibility that HBOT improves outcome in patients with mastectomy flap ischaemia.
高压氧治疗（HBOT）已被提议作为一种有效的干预措施，以限制乳腺癌术后缺血皮瓣的坏死。本研究的目的是评估迄今为止最大系列接受 HBOT 治疗的乳腺癌皮瓣缺血患者的结果。
对 50 例因乳腺癌皮瓣缺血而需要 HBOT 的乳房进行回顾性分析。四名独立观察者使用皮肤缺血坏死（SKIN）评分评估缺血或坏死的严重程度。使用多变量逻辑回归分析评估风险因素与再手术之间的关系。
HBOT 于手术后中位数 3 天（范围 1-23 天）开始，中位数持续 12 次（范围 6-22 次）。通过独立观察者对 175 次乳房 SKIN 表面积评分（观察）的评估显示，有 34%（观察）的评分改善，42%（均 P<0.01）的评分恶化。表面积和深度评分均与再次手术的需要相关：反映乳腺癌皮瓣更严重坏死的评分越高，再次手术的需求越高。29 例乳房（58%）无需进一步手术即可恢复。多变量分析显示，术前放疗（OR 7.2，95%CI 1.4-37.3）和术后感染（OR 15.4，95%CI 2.6-89.7）是再次手术的风险因素。
在本病例系列中，HBOT 期间缺血乳房的表面积减小，大多数乳房（58%）无需进一步手术。需要进行随机对照试验以证实或反驳 HBOT 改善乳腺癌皮瓣缺血患者结局的可能性。
