From the Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine.
McGovern Medical School, University of Texas Health Science Center at Houston.
Plast Reconstr Surg. 2024 Jun 1;153(6):1073e-1079e. doi: 10.1097/PRS.0000000000010817. Epub 2023 Jun 7.
The skin ischemia and necrosis (SKIN) score was introduced to standardize the assessment of mastectomy skin flap necrosis (MSFN) severity and the need for reoperation. The authors evaluated the association between the SKIN score and the long-term postoperative outcomes of MSFN after mastectomy and immediate breast reconstruction.
The authors conducted a retrospective cohort study of consecutive patients who developed MSFN after mastectomy and immediate breast reconstruction from January of 2001 to January of 2021. The primary outcome was breast-related complications after MSFN. Secondary outcomes were 30-day readmission, operating room (OR) débridement, and reoperation. Study outcomes were correlated with the SKIN composite score.
The authors identified 299 reconstructions in 273 consecutive patients with mean follow-up time of 111.8 ± 3.9 months. Most patients had a composite SKIN score of B2 (25.0%, n = 13), followed by D2 (17.3%) and C2 (15.4%). We found no significant difference in rates of OR débridement ( P = 0.347), 30-day readmission ( P = 0.167), any complication ( P = 0.492), or reoperation for a complication ( P = 0.189) based on the SKIN composite score. The composite skin score was a poor predictor of reoperation, with an area under the curve of 0.56. A subgroup analysis in patients who underwent implant-based reconstruction revealed no difference in rates of OR débridement ( P = 0.986), 30-day readmission ( P = 0.530), any complication ( P = 0.492), or reoperation for a complication ( P = 0.655) based on the SKIN composite score.
The SKIN score was a poor predictor for postoperative MSFN outcomes and reoperation. An individualized risk-assessment tool that incorporates the anatomic appearance of the breast, imaging data, and patient-level risk factors is needed.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.
皮肤缺血坏死（SKIN）评分的引入是为了标准化评估乳房切除术皮瓣坏死（MSFN）的严重程度和再次手术的需要。作者评估了 SKIN 评分与乳房切除和即刻乳房重建后 MSFN 的长期术后结果之间的关系。
作者对 2001 年 1 月至 2021 年 1 月期间连续发生乳房切除和即刻乳房重建后 MSFN 的患者进行了回顾性队列研究。主要结果是 MSFN 后的乳房相关并发症。次要结果是 30 天再入院、手术室（OR）清创和再次手术。研究结果与 SKIN 综合评分相关。
作者确定了 273 例连续患者的 299 次重建，平均随访时间为 111.8±3.9 个月。大多数患者的 SKIN 综合评分为 B2（25.0%，n=13），其次是 D2（17.3%）和 C2（15.4%）。我们发现，根据 SKIN 综合评分，OR 清创术（P=0.347）、30 天再入院率（P=0.167）、任何并发症发生率（P=0.492）或并发症再次手术率（P=0.189）均无显著差异。综合皮肤评分是再次手术的不良预测指标，曲线下面积为 0.56。在接受植入物为基础的重建的患者亚组分析中，根据 SKIN 综合评分，OR 清创术（P=0.986）、30 天再入院率（P=0.530）、任何并发症发生率（P=0.492）或并发症再次手术率（P=0.655）均无差异。
SKIN 评分是预测 MSFN 术后结果和再次手术的不良指标。需要一种个体化的风险评估工具，该工具应结合乳房的解剖外观、影像学数据和患者的危险因素。
临床问题/证据水平：风险，IV。
