From the Division of Plastic Surgery, Montefiore Medical Center.
Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine.
Plast Reconstr Surg. 2023 Oct 1;152(4):728-735. doi: 10.1097/PRS.0000000000010349. Epub 2023 Mar 3.
Mastectomy flap necrosis (MFN) is a common complication of immediate breast reconstruction that greatly affects patient satisfaction and cosmetic outcomes. Topical nitroglycerin ointment, with its low cost and negligible side effects, has been shown to significantly decrease the incidence of MFN in immediate implant-based breast reconstruction, but its utility has not been studied in immediate autologous reconstruction.
With institutional review board approval, a prospective cohort study was performed of all consecutive patients undergoing immediate free-flap breast reconstruction by a single reconstructive surgeon at a single institution between February of 2017 and September of 2021. Patients were divided into two cohorts: those who received 30 mg of topical nitroglycerin ointment to each breast at the conclusion of the operation (September of 2019 to September of 2021) and those who did not (February of 2017 to August of 2019). All patients underwent intraoperative SPY angiography, and mastectomy skin flaps were débrided intraoperatively based on imaging. Independent demographic variables were analyzed, and dependent outcome variables included mastectomy skin flap necrosis, headache, and hypotension requiring removal of ointment.
A total of 35 patients (49 breasts) were included in the nitroglycerin cohort and 34 patients (49 breasts) were included in the control group. There was no significant difference in patient demographics, medical comorbidities, or mastectomy weight between cohorts. The rate of MFN decreased from 51% in the control group to 26.5% in the group that received nitroglycerin ointment ( P = 0.013). There were no documented adverse events associated with nitroglycerin use.
Topical nitroglycerin ointment significantly decreases the rate of MFN in patients undergoing immediate autologous breast reconstruction without significant adverse effects.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
乳房切除术皮瓣坏死（MFN）是即刻乳房重建的常见并发症，极大地影响了患者的满意度和美容效果。局部硝酸甘油软膏具有成本低、副作用小的优点，已被证明可显著降低即刻植入物乳房重建中 MFN 的发生率，但尚未在即刻自体重建中进行研究。
经机构审查委员会批准，对 2017 年 2 月至 2021 年 9 月期间由一位单外科医生在单机构进行的所有连续接受即刻游离皮瓣乳房重建的患者进行了前瞻性队列研究。患者分为两组：一组在手术结束时（2019 年 9 月至 2021 年 9 月）接受每侧乳房 30mg 局部硝酸甘油软膏（n=18），另一组不接受（2017 年 2 月至 2019 年 8 月）。所有患者均接受术中 SPY 血管造影，根据影像对乳房切除术皮瓣进行清创。分析独立的人口统计学变量，并且依赖的结果变量包括乳房切除术皮瓣坏死、头痛和需要去除软膏的低血压。
共有 35 例患者（49 侧乳房）纳入硝酸甘油组，34 例患者（49 侧乳房）纳入对照组。两组患者的人口统计学、合并症或乳房切除术重量无显著差异。对照组 MFN 发生率为 51%，而接受硝酸甘油软膏的组发生率为 26.5%（P=0.013）。使用硝酸甘油没有记录到不良反应。
在接受即刻自体乳房重建的患者中，局部硝酸甘油软膏可显著降低 MFN 的发生率，且无明显不良反应。
临床问题/证据水平：治疗性，II 级。
