Al-Saghir Tala, Vraa Alexander, Sawar Kinan, Jacobsen Gordon, Evangelista Maristella S, Atisha Dunya
From the Wayne State University School of Medicine, Detroit, Mich.
Department of General Surgery, Henry Ford Hospital, Detroit, Mich.
Plast Reconstr Surg Glob Open. 2024 Mar 1;12(3):e5657. doi: 10.1097/GOX.0000000000005657. eCollection 2024 Mar.
Marijuana use has been associated with vascular inflammation and clotting, resulting in endothelial damage and arteritis. As marijuana use rises in the United States, few studies have evaluated its impact on surgical outcomes and wound healing in free flap breast reconstruction.
A retrospective cohort study of patients undergoing abdominal free flap breast reconstruction between 2016 and 2022 at a large metropolitan healthcare system was performed. Patient demographics, comorbidities, procedural details, and complications were analyzed. Minor complications were defined as skin or fat necrosis not requiring intervention, nipple loss, any wound requiring management in the clinic, hematoma, and seroma. Major complications were defined as reoperation, flap loss, cardiac or thromboembolic events, and hospital readmission. Active marijuana users were those with marijuana use within 12 weeks of surgery.
In total, 168 patients underwent 276 deep inferior epigastric artery-based flaps for breast reconstruction. There were 21 active marijuana users. There were no significant differences in patient demographics, cancer treatment, or minor and major complications. However, there were higher rates of active nicotine use ( = 0.001) and anxiety/depression amongst active marijuana users ( = 0.002). Active users had higher rates of bilateral breast reconstruction ( = 0.029), but no significant differences in other operative details.
Active marijuana use of unknown frequency may be safe in patients undergoing breast free flap reconstruction. Advising marijuana abstinence preoperatively may not alter patient outcomes. Further studies of greater sample size are needed to evaluate marijuana's impact on outcomes associated with breast reconstruction using free flap.
使用大麻与血管炎症和凝血有关，会导致内皮损伤和动脉炎。随着美国大麻使用量的增加，很少有研究评估其对游离皮瓣乳房重建手术结果和伤口愈合的影响。
对2016年至2022年期间在一个大型都市医疗系统接受腹部游离皮瓣乳房重建的患者进行回顾性队列研究。分析了患者的人口统计学特征、合并症、手术细节和并发症。轻微并发症定义为无需干预的皮肤或脂肪坏死、乳头丢失、任何需要在门诊处理的伤口、血肿和血清肿。严重并发症定义为再次手术、皮瓣丢失、心脏或血栓栓塞事件以及再次入院。近期大麻使用者是指在手术前12周内使用过大麻的患者。
共有168例患者接受了276例基于腹壁下深动脉的皮瓣进行乳房重建。有21名近期大麻使用者。在患者人口统计学特征、癌症治疗或轻微和严重并发症方面没有显著差异。然而，近期大麻使用者中当前吸烟率更高（P = 0.001），焦虑/抑郁发生率更高（P = 0.002）。近期使用者双侧乳房重建率更高（P = 0.029），但在其他手术细节方面没有显著差异。
对于接受游离皮瓣乳房重建的患者，使用频率不明的近期大麻使用可能是安全的。术前建议患者戒除大麻可能不会改变手术结果。需要进行更大样本量的进一步研究，以评估大麻对游离皮瓣乳房重建相关结果的影响。
