Engel Ricardo, Greenberg Yitzchok, Siddiqui Aamir
Wayne State University School of Medicine, 540 E Canfield, Detroit, MI, 48201, USA.
Henry Ford Health System, Detroit, MI, USA.
Aesthetic Plast Surg. 2022 Feb;46(1):108-112. doi: 10.1007/s00266-021-02492-0. Epub 2021 Aug 5.
Large volume breast reductions are at increased risk of nipple ischemia and necrosis due to tenuous blood supply of long pedicles. We adapted incisional negative pressure wound therapy to augment nipple survival in such patients undergoing mammaplasty by inferior pedicle technique.
Patients with nipple-to-inframammary fold distance >14 cm were informed of increased risk of requiring free nipple graft. All patients underwent inferior pedicle technique with Wise pattern skin incision. Once incisions were closed and the nipple-areolar complex was inset, the complex was assessed for vascularity. In 12 cases there was evidence of compromised arterial inflow or venous outflow. For these patients, incisional negative pressure wound therapy was applied to the bilateral nipple-areolar complexes for 5-7 days.
None of the 12 patients (24 breasts) in this series experienced nipple-areolar complex ischemia or necrosis. Only 2 patients experienced delayed wound healing which was successfully managed by local wound care.
This study demonstrates the utility of negative pressure wound therapy in nipple survival for at-risk patients. We believe it augments healing by allowing improved micro-circulation.
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由于长蒂的血供脆弱，大容量乳房缩小术发生乳头缺血和坏死的风险增加。我们采用切口负压伤口治疗，以提高接受下蒂技术乳房成形术的此类患者的乳头存活率。
乳头至乳房下皱襞距离>14 cm的患者被告知需要游离乳头移植的风险增加。所有患者均采用下蒂技术及Wise型皮肤切口。切口关闭且乳头乳晕复合体就位后，评估复合体的血运情况。12例患者有动脉流入或静脉流出受损的证据。对于这些患者，双侧乳头乳晕复合体采用切口负压伤口治疗5 - 7天。
本系列12例患者（24个乳房）均未发生乳头乳晕复合体缺血或坏死。仅2例患者出现伤口愈合延迟，经局部伤口护理成功处理。
本研究证明了负压伤口治疗对有风险患者乳头存活的作用。我们认为它通过改善微循环促进愈合。
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