皮下神经丛密度与接受缩乳术患者的肥胖及伤口并发症的关系
Subdermal Plexus Density as It Relates to Obesity and Wound Complications in Patients Undergoing Reduction Mammaplasty.
作者信息
Brown Kathryn W, McCandless Martin G, Nannapaneni Hemanth, Adams Kristen, Songcharoen Somjade Jay, Arnold Peter B
机构信息
Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, Mississippi.
School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
出版信息
Eplasty. 2023 Jun 19;23:e36. eCollection 2023.
BACKGROUND
Reduction mammaplasty is one of the most common reconstructive procedures performed in plastic surgery. Multiple comorbidities play a role in postoperative wound healing complications; however, there are insufficient data on the subdermal plexus (SDP) as it relates to these comorbidities. The purpose of this study is to evaluate the relationship between body mass index (BMI) and SDP of the superficial breast tissues and examine the association between SDP and postoperative complications.
METHODS
After Institutional Review Board approval, screening, and informed consent, patients undergoing reduction mammaplasty were selected. Tissue to be discarded was sent to pathology for analysis of immunohistochemistry directed against endothelial cells to determine the density of the SDP. Patients with BMI <35 and ≥35 kg/m were compared. Statistical analysis, including 2-tailed test and Pearson correlation, was conducted.
RESULTS
A significant difference in SDP density (standard deviation) was identified between patients with a BMI ≥35 versus <35 kg/m (2.65 capillaries/mm ± 1.8 vs 1.56 capillaries/mm ± 1.2; = .033). Patients with no historical use of tobacco versus those who used tobacco showed a significantly increased SDP (2.11 capillaries/mm ± 1.6 vs 1.20 capillaries/mm ± 0.5; = .009). A significant relationship between postoperative infection (1.00 capillaries/mm ± 1.1; = .041) and hematoma/seroma (0.788 capillaries/mm ± 0.1; = .003) was identified. No significant relationship was found between SDP and delayed wound healing, nipple-areolar complex complications, fat/flap necrosis, or symptomatic scar occurrence.
CONCLUSIONS
There is a statistically significant increase in SDP seen with increasing BMI, which does not explain the higher rate of wound healing complications after reduction mammaplasty typically seen in the higher BMI patient population. The association between BMI and complications after reduction mammaplasty remains unclear.
背景
缩乳术是整形外科中最常见的重建手术之一。多种合并症在术后伤口愈合并发症中起作用；然而，关于皮下血管丛（SDP）与这些合并症的关系，数据不足。本研究的目的是评估体重指数（BMI）与乳腺浅表组织SDP之间的关系，并研究SDP与术后并发症之间的关联。
方法
经机构审查委员会批准、筛选并获得知情同意后，选择接受缩乳术的患者。将废弃组织送去进行病理学分析，通过针对内皮细胞的免疫组织化学来确定SDP的密度。对BMI<35和≥35kg/m²的患者进行比较。进行了包括双侧t检验和Pearson相关性分析在内的统计分析。
结果
BMI≥35kg/m²与<35kg/m²的患者之间，SDP密度（标准差）存在显著差异（2.65条毛细血管/mm²±1.8对1.56条毛细血管/mm²±1.2；P =.033）。无吸烟史的患者与吸烟患者相比，SDP显著增加（2.11条毛细血管/mm²±1.6对1.20条毛细血管/mm²±0.5；P =.009）。确定术后感染（1.00条毛细血管/mm²±1.1；P =.041）和血肿/血清肿（0.788条毛细血管/mm²±0.1；P =.003）之间存在显著关系。未发现SDP与伤口愈合延迟、乳头乳晕复合体并发症、脂肪/皮瓣坏死或有症状瘢痕的发生之间存在显著关系。
结论
随着BMI的增加，SDP在统计学上显著增加，但这并不能解释BMI较高的患者群体中缩乳术后伤口愈合并发症发生率较高的现象。BMI与缩乳术后并发症之间的关联仍不清楚。
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