From the Kimmel Hyperbaric and Advanced Wound Healing Center, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY.
Ann Plast Surg. 2023 May 1;90(5S Suppl 2):S125-S129. doi: 10.1097/SAP.0000000000003441. Epub 2023 Mar 8.
Nipple-sparing mastectomy (NSM) is emerging as the standard of care for treatment of breast cancer because of its oncologic safety and superior aesthetic outcomes. However, ischemia or necrosis of the skin flap and/or nipple-areola complex remain frequent complications. Hyperbaric oxygen therapy (HBOT) has emerged as a potential adjunct for flap salvage, although it is not currently a widely accepted practice. Here we review our institution's experience using a protocol of HBOT in patients with signs of flap ischemia or necrosis after NSM.
Retrospective review identified all patients treated with HBOT at our institution's hyperbaric and wound care center because of signs of ischemia after NSM. Treatment parameters consisted of 90-minute dives at 2.0 atmosphere once or twice daily. Patients unable to tolerate dives were considered a treatment failure, whereas those lost to follow-up were excluded from analysis. Patient demographics, surgical characteristics, and treatment indications were recorded. Primary outcomes assessed were flap salvage (no operative revision), need for revision procedures, and treatment complications.
A total of 17 patients and 25 breasts met the inclusion criteria. The mean ± SD time to initiation of HBOT was 9.47 ± 12.7 days. The mean ± SD age was 46.7 ± 10.4 years, and mean ± SD follow-up time was 36.5 ± 25.6 days. Indications for NSM included invasive cancer (41.2%), carcinoma in situ (29.4%), and breast cancer prophylaxis (29.4%). Initial reconstruction included tissue-expander placement (47.1%), autologous reconstruction with deep inferior epigastric flaps (29.4%), and direct-to-implant reconstruction (23.5%). Hyperbaric oxygen therapy indications included ischemia or venous congestion for 15 breasts (60.0%) and partial thickness necrosis for 10 breasts (40.0%). Flap salvage was achieved in 22 of 25 breasts (88.0%). Reoperation was required for 3 breasts (12.0%). Hyperbaric oxygen therapy-related complications were observed in 4 patients (23.5%), which included 3 patients with mild ear pain and 1 patient with severe sinus pressure leading to treatment abortion.
Nipple-sparing mastectomy is an invaluable tool for breast and plastic surgeons to achieve oncologic and cosmetic goals. However, ischemia or necrosis of the nipple-areola complex or mastectomy skin flap remains frequent complications. Hyperbaric oxygen therapy has emerged as a possible intervention for threatened flaps. Our results demonstrate the utility of HBOT in this population to achieve excellent NSM flap salvage rates.
由于其肿瘤安全性和优越的美学效果，保留乳头的乳房切除术（NSM）正成为治疗乳腺癌的标准方法。然而，皮瓣和/或乳头乳晕复合体缺血或坏死仍然是常见的并发症。高压氧治疗（HBOT）已成为皮瓣挽救的一种潜在辅助手段，尽管它目前还不是一种广泛接受的做法。在这里，我们回顾了我们机构在 NSM 后出现皮瓣缺血或坏死迹象的患者中使用 HBOT 方案的经验。
回顾性分析了在我们机构高压氧和伤口护理中心因 NSM 后出现缺血迹象而接受 HBOT 治疗的所有患者。治疗参数包括在 2.0 大气压下潜水 90 分钟，每天一次或两次。无法耐受潜水的患者被认为治疗失败，而失去随访的患者则被排除在分析之外。记录患者的人口统计学、手术特征和治疗指征。主要评估结果是皮瓣挽救（无需手术修正）、需要修正手术的情况以及治疗并发症。
共有 17 名患者和 25 只乳房符合纳入标准。HBOT 开始的平均时间±标准差为 9.47±12.7 天。平均年龄±标准差为 46.7±10.4 岁，平均随访时间±标准差为 36.5±25.6 天。NSM 的指征包括浸润性癌（41.2%）、原位癌（29.4%）和乳腺癌预防（29.4%）。初始重建包括组织扩张器放置（47.1%）、腹壁下深动脉游离皮瓣自体重建（29.4%）和直接植入物重建（23.5%）。HBOT 的指征包括缺血或静脉充血的乳房 15 个（60.0%）和部分厚度坏死的乳房 10 个（40.0%）。25 个乳房中的 22 个（88.0%）实现了皮瓣挽救。需要对 3 个乳房（12.0%）进行再次手术。4 名患者（23.5%）出现与 HBOT 相关的并发症，包括 3 名患者出现轻度耳痛和 1 名患者出现严重鼻窦压力导致治疗中止。
保留乳头的乳房切除术是乳腺和整形外科医生实现肿瘤学和美容目标的宝贵工具。然而，乳头乳晕复合体或乳房皮瓣缺血或坏死仍然是常见的并发症。高压氧治疗已成为一种可能的治疗方法。我们的结果表明，HBOT 在该人群中可以达到极好的 NSM 皮瓣挽救率。
