Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden.
Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Perimed AB, Järfälla, Stockholm, Sweden.
Breast. 2024 Jun;75:103704. doi: 10.1016/j.breast.2024.103704. Epub 2024 Mar 6.
The pathophysiological mechanism behind complications associated with postmastectomy radiotherapy (PMRT) and subsequent implant-based breast reconstruction are not completely understood. The aim of this study was to examine if there is a relationship between PMRT and microvascular perfusion and saturation in the skin after mastectomy and assess if there is impaired responsiveness to a topically applied vasodilator (Methyl nicotinate - MN). Skin microvascular perfusion and oxygenation >2 years after PMRT were measured using white light diffuse reflectance spectroscopy (DRS) and laser Doppler flowmetry (LDF) in the irradiated chest wall of 31 women with the contralateral breast as a control. In the non-irradiated breast, the perfusion after application of MN (median 0.84, 25th-75th centile 0.59-1.02 % RBC × mm/s) was higher compared to the irradiated chest wall (median 0.51, 25th-75th centile 0.21-0.68 % RBC × mm/s, p < 0.001). The same phenomenon was noted for saturation (median 91 %, 25th-75th centile 89-94 % compared to 89 % 25th-75th centile 77-93 %, p = 0.001). Eight of the women (26%) had a ≥10 % difference in skin oxygenation between the non-irradiated breast and the irradiated chest wall. These results indicate that late microvascular changes caused by radiotherapy of the chest wall significantly affect skin perfusion and oxygenation.
乳腺癌根治术后放疗（PMRT）及随后的植入式乳房重建相关并发症的病理生理机制尚未完全阐明。本研究旨在探讨 PMRT 是否与乳房切除术后皮肤的微血管灌注和饱和度有关，并评估其是否会影响局部应用血管扩张剂（烟碱酸甲酯-MN）的反应性。对 31 例接受 PMRT 的女性的患侧胸壁和对侧乳房（对照组）进行了为期 2 年以上的皮肤微血管灌注和氧合的白光漫反射光谱（DRS）和激光多普勒血流仪（LDF）检测。与照射后的胸壁（中位数 0.51，25-75%分位数 0.21-0.68%RBC×mm/s）相比，MN 应用后的非照射乳房的灌注（中位数 0.84，25-75%分位数 0.59-1.02%RBC×mm/s）更高（p<0.001）。饱和度也存在同样的现象（中位数 91%，25-75%分位数 89-94%与 89%，25-75%分位数 77-93%，p=0.001）。8 名女性（26%）的非照射乳房和照射后的胸壁之间的皮肤氧合存在≥10%的差异。这些结果表明，胸壁放射治疗引起的迟发性微血管变化显著影响皮肤灌注和氧合。
