From the Department of Plastic and Reconstructive Surgery.
Department of General Surgery, Ewha Womans University College of Medicine, Mokdong Hospital.
Plast Reconstr Surg. 2024 Aug 1;154(2):278-286. doi: 10.1097/PRS.0000000000010991. Epub 2023 Aug 15.
Necrosis of a cutaneous flap including the nipple-areola complex is a common complication in immediate implant-based breast reconstruction following nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM). This study aimed to evaluate the efficacy of prostaglandin E1 (PGE1) in reducing such complications.
A retrospective analysis of prospectively collected data was conducted at two centers, and the cohort consisted of patients undergoing NSM/SSM followed by immediate reconstruction with a prosthesis. Patients who were randomly allocated to the treatment group were administered daily intravenous PGE1 (10 μg/2 mL) beginning intraoperatively through postoperative day 6. Skin flap complications including nipple/skin necrosis, delayed wound healing, and postoperative wound revision were recorded. Complication rates were compared between the PGE1 and control groups.
A total of 276 breasts in 259 patients were included for analysis (139 breasts in the treatment group and 137 breasts in the control group). There was no difference in patient demographics between the control and treatment groups. Reconstructed breasts receiving PGE1 had significantly lower rates of overall skin complications (21.6% versus 34.3%; P = 0.022) and wound revision (2.9% versus 9.5%; P = 0.025). Among NSM cases, the PGE1 group showed a significantly lower rate of nipple necrosis (15.5% versus 29.4%; P = 0.027). In the multivariate analysis, the use of PGE1 significantly reduced the risk of overall skin flap complications (OR, 0.491; P = 0.018) and wound revision (OR, 0.213; P = 0.018) in NSM/SSM cases, and nipple necrosis (OR, 0.357; P = 0.008) in NSM cases.
PGE1 can be effective in reducing risk of mastectomy flap complications in immediate implant-based breast reconstructions.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在保留乳头乳晕复合体的即刻假体乳房重建术后，皮瓣坏死是一种常见并发症，包括乳头乳晕复合体在内的坏死。本研究旨在评估前列腺素 E1（PGE1）在减少此类并发症中的作用。
对两个中心前瞻性收集的数据进行回顾性分析，队列包括接受保留乳头乳晕复合体的乳房切除术/保留皮肤的乳房切除术（SSM）后即刻行假体乳房重建的患者。随机分配至治疗组的患者术中开始每日静脉注射 PGE1（10 μg/2 mL），持续至术后第 6 天。记录皮瓣并发症，包括乳头/皮肤坏死、延迟愈合和术后伤口修正。比较 PGE1 组和对照组的并发症发生率。
共纳入 259 例患者的 276 个乳房进行分析（治疗组 139 个乳房，对照组 137 个乳房）。对照组和治疗组患者的人口统计学特征无差异。接受 PGE1 的重建乳房的总体皮肤并发症发生率（21.6%比 34.3%；P=0.022）和伤口修正率（2.9%比 9.5%；P=0.025）显著较低。在 SSM 病例中，PGE1 组乳头坏死的发生率显著较低（15.5%比 29.4%；P=0.027）。在多变量分析中，PGE1 的使用显著降低了 SSM/SSM 病例的总体皮瓣并发症风险（OR，0.491；P=0.018）和伤口修正风险（OR，0.213；P=0.018），以及 SSM 病例的乳头坏死风险（OR，0.357；P=0.008）。
PGE1 可有效降低即刻假体乳房重建中乳房切除术皮瓣并发症的风险。
临床问题/证据水平：治疗性，III 级。
