BackgroundLymphedema is an edematous condition that afflicts the postmastectomy breast cancer population, with diminished quality of life with substantial financial costs. The factors predictive of postmastectomy lymphedema development in breast cancer patients are unknown. The objective was to evaluate the trends over time in lymphedema development and the risk factors predictive of lymphedema-related events within 2 years of mastectomy.MethodsUsing the New York Statewide Planning and Research Cooperative System multicenter deidentified database from 2010 to 2016, a total of 65,543 breast cancer postmastectomy female patients (mean age, 59 ± 20 years) were identified across 177 facilities. The breast cancer patients were followed for any 2-year postmastectomy lymphedema-related events. A multivariable model identified predictors of 2-year lymphedema using eligible variables involving demographics, comorbidities, and complications. Elixhauser score was defined as a comorbidity index based on International Classification of Diseases codes used in hospital settings.ResultsOverall, 5.2% (n = 3409) of the breast cancer postmastectomy patients experienced a lymphedema-related event within 2 years of initial surgery. Over time, 2-year postmastectomy lymphedema rates have more than doubled from 4.62% in 2010 to 9.75% in 2016 (P < 0.001). Two-year postmastectomy lymphedema rates varied significantly by mastectomy procedure type: 5.69% of the mastectomy-only procedures, 5.96% of the mastectomies with lymph node biopsies, and 7.83% of the mastectomies with lymph node dissections (P < 0.0001). Full mastectomies had a greater 2-year lymphedema rate of 7.31% when compared with partial mastectomies with 2.79% (P < 0.0001). The top predictive risk factors for a lymphedema-related event included higher Elixhauser score, prolonged hospitalization for mastectomy, more recent mastectomy procedure, obesity, younger age, non-Asian race, Medicaid insurance, and hypertension (all P's < 0.01).ConclusionsAlthough more recent postmastectomy lymphedema rates may not be as high as historical estimates, the 2-year postmastectomy lymphedema rates have more than doubled from 2010 to 2016 requiring further elucidation as well as continued focus on treatment. Furthermore, risk factors were identified that predispose postmastectomy breast cancer patients to developing lymphedema. Given these findings, perioperative screening seems warranted to proactively identify, educate, and monitor postmastectomy patients at greatest risk of future lymphedema development.
Introduction Both high-voltage (>1000 V) and low-voltage (< 1000 V) electrical burns can cause serious injuries due to dissipation of heat as electric current passes through deep tissues. Because of tissue loss and vital structure exposure, flap-based reconstruction is frequently performed in patients with these injuries. Depending on clinical presentation, both free and pedicled flaps may be indicated. We wondered if reported reconstructive outcomes after electrical injury differ between free and pedicled flaps when implemented in the immediate post-injury period. Methods A systematic literature review following PRISMA guidelines was conducted using PubMed and Ovid MEDLINE databases. Articles that were included described patients with electrical burn injuries who underwent reconstruction with either free or pedicled flaps within 90 days of injury. Technique articles or articles lacking outcomes analysis were excluded. Data was extracted from articles that met inclusion and exclusion criteria, including flap type, timing of reconstruction, complications, and patient demographics. Statistical analysis was performed with chi-square tests. Results Of 536 articles obtained from the literature search, 37 met criteria. To date, no randomized control trials comparing these modalities have been performed. In total, these studies reported on 364 total patients who experienced high- and low-voltage electrical burn injuries. Pooled reported outcomes of 374 flap reconstructions were analyzed, including 145 free flaps and 229 pedicled flaps. Reported complication rates did not differ significantly between free flaps (30/145, 20.7%) and pedicled flaps (46/229, 20.1%; p = .89). However, free flaps experienced significantly higher failure rates than pedicled flaps (13/145, 9.0% vs. 0/229, 0%; p = < .05). Conclusions Electrical burn injuries present a unique indication for flap-based reconstruction in the immediate post-burn phase of care. However, substantial variation exists amongst physicians regarding whether to proceed with a free flap or pedicled flap surgery when indicated. Our data identified an overall significant difference between free versus pedicled flap failure rate but did not identify a significant difference between overall complication rates.
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