Mastectomy skin flap necrosis: challenges and solutions
Mastectomy skin flap necrosis: challenges and solutions
INTRODUCTION: Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%-30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions.
METHODS: A MEDLINE search was performed using the search term "mastectomy skin flap necrosis". Titles and abstracts from peer-reviewed publications were screened for relevance.
RESULTS: MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited.
CONCLUSION: MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.
Journal Article, Review
141-152
Robertson, Stuart A.
c5c56354-4e64-4f40-a804-091082f54eed
Jeevaratnam, Johann A.
2d1c5b0c-3320-4176-bab9-3610ce03309f
Agrawal, Avi
4937e9b8-a281-47d7-93bf-6ea06654bb6d
Cutress, Ramsey I.
68ae4f86-e8cf-411f-a335-cdba51797406
Robertson, Stuart A.
c5c56354-4e64-4f40-a804-091082f54eed
Jeevaratnam, Johann A.
2d1c5b0c-3320-4176-bab9-3610ce03309f
Agrawal, Avi
4937e9b8-a281-47d7-93bf-6ea06654bb6d
Cutress, Ramsey I.
68ae4f86-e8cf-411f-a335-cdba51797406
Robertson, Stuart A., Jeevaratnam, Johann A., Agrawal, Avi and Cutress, Ramsey I.
(2017)
Mastectomy skin flap necrosis: challenges and solutions.
Breast Cancer, 9, .
(doi:10.2147/BCTT.S81712).
Abstract
INTRODUCTION: Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%-30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions.
METHODS: A MEDLINE search was performed using the search term "mastectomy skin flap necrosis". Titles and abstracts from peer-reviewed publications were screened for relevance.
RESULTS: MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited.
CONCLUSION: MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.
Text
FINAL Mastectomy Skin Flap Necrosis Review Resubmission
- Accepted Manuscript
Text
BCTT-81712-mastectomy-skin-flap-necrosis--challenges-and-solutions_031317
- Version of Record
More information
Accepted/In Press date: 16 January 2017
e-pub ahead of print date: 13 March 2017
Keywords:
Journal Article, Review
Identifiers
Local EPrints ID: 413281
URI: http://eprints.soton.ac.uk/id/eprint/413281
ISSN: 1179-1314
PURE UUID: 64904100-6261-4b12-a131-cf1af9434fa4
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Date deposited: 18 Aug 2017 16:31
Last modified: 15 Mar 2024 13:17
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Author:
Stuart A. Robertson
Author:
Johann A. Jeevaratnam
Author:
Avi Agrawal
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