Effects of Nitroglycerin Ointment on Mastectomy Flap Necrosis in Immediate Breast Reconstruction

Gdalevitch, Perry; Laeken, Nancy Van; Bahng, Seokjae; Ho, Adelyn L.; Bovill, Esta S.; Lennox, Peter; Brasher, Penelope M. A.; Macadam, Sheina A.

doi:10.1097/prs.0000000000001237

Cited by 70 publications

(57 citation statements)

References 34 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A meta-analysis by Basta concluded that the risk of implant loss may decrease as the quality of the mastectomy tissue increases 10 . Gdalevitch et al and Turin et al reported that there were no significant differences in implant loss between NTG and control groups 19,21 . The results of our meta-analysis are in agreement with the findings mentioned above.…”

Section: Discussionmentioning

confidence: 95%

“…Turin et al 21 divided debridement procedures according to whether they were performed in the office or the operating room; it was found that NTG could significantly reduce the total and in-office debridement rates but could not reduce the rate of debridement in the operating room. Gdalevitch et al divided debridement cases into a local anesthesia group and a general anesthesia group 19 , finding that NTG could not reduce the debridement rate in both groups. Similar to Turin's work, our study found that the debridement rate decreased significantly after the use of NTG (OR, 0.32; 95% CI, 0.21-0.51; P < 0.01), which suggested that the use of NTG reduced the probability of reoperation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of topical nitroglycerin in the prevention of mastectomy flap necrosis: a systematic review and meta-analysis

Wang

Qin

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Flap necrosis is a common complication after mastectomy, and nitroglycerin (NTG) ointment has been used successfully to treat it. However, it is not clear whether topical NTG can completely prevent the occurrence of flap necrosis after breast cancer surgery, and it is also unclear whether this treatment may cause side effects. Three randomized controlled trials (RCTs) and two retrospective cohort studies (RCSs) were included in our investigation. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that NTG significantly reduced the rates of mastectomy flap necrosis, full-thickness flap necrosis, and debridement as well as the rate of early complications other than flap necrosis. However, there was no significant difference in drug-related adverse reactions, explantation, superficial flap necrosis, infection, hematoma or seroma between the NTG and placebo groups. Flap-related complications are extremely common after breast surgery, among them, flap necrosis is the most serious and leads to a poor prognosis. In the literature, the reported rates of mastectomy flap necrosis (MFN) range from 5% to 30% 1-9. The rate may continue to rise as nipple-sparing mastectomy and immediate breast reconstruction (IBR) become more prevalent in young breast cancer patients, although there is some evidence that the risks of flap necrosis and implant failure are higher in IBR than in mastectomy alone 10. Nitroglycerin (NTG) effectively increases local blood flow by dilating arteries and veins without altering the ratio of precapillary to postcapillary resistance. Many studies have shown that NTG treatment may improve the survival of random-pattern skin flaps by increasing local blood flow 11-13. Nonetheless, not all studies confirm the utility of NTG in skin flap preservation. Several scholars have found that daily application of NTG slow-release pads offer no greater flap survival than a control treatment 14-17. Furthermore, some of the side effects of NTG may limit its use. However, Ricci has argued that NTG is safe and effective and does not increase the occurrence of side effects 18. Given the lack of consensus on the use of NTG to prevent MFN, the purpose of this meta-analysis is to determine the efficacy and safety of NTG for the prevention of MFN. Debridement is an important solution to skin flap necrosis, but it causes psychological and physical trauma to patients. Further attention should be paid to the debridement rate after mastectomy, especially after IBR, in which circumstances it may cause the tissue expander/implant to be lost. Unfortunately, some studies have suggested that NTG cannot reduce the rate of debridement after IBR 19-21. Hence, another purpose of this article is to determine whether NTG can reduce the flap debridement rate after mastectomy.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of topical nitroglycerin in the prevention of mastectomy flap necrosis: a systematic review and meta-analysis

Wang

Qin

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Interestingly, Gdalevitch et al100 from the University of British Columbia have recently reported the results of an RCT into the effects of applying nitroglycerin ointment (a potent topical vasodilator of both arteries and veins) to mastectomy skin flaps following immediate reconstruction. A single application of 45 mg of nitroglycerin ointment (2%) was applied to the mastectomy skin flaps at the end of the operation at the time of dressing application, and the dressings were left in place for 48 hours.…”

Section: Resultsmentioning

confidence: 99%

Mastectomy skin flap necrosis: challenges and solutions

Robertson¹,

Jeevaratnam²,

Agrawal³

et al. 2017

BCTT

102

View full text Add to dashboard Cite

IntroductionMastectomy 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.MethodsA MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance.ResultsMSFN 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.ConclusionMSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.

show abstract

“…8 Its use is well-studied in breast reconstruction, with level-1 evidence showing its efficacy in reducing flap necrosis when applied immediately after surgery, left in place for at least 48 hours. 9 In facial plastic surgery, its use has been described for the use of impending necrosis from filler injections, in combination with hyaluronidase. 10…”

Section: Management Of Early Complications Topical Nitratesmentioning

confidence: 99%

Management of Complications from Skin Cancer Reconstruction

Vila

Thomas

2020

Facial Plast Surg

View full text Add to dashboard Cite

Reconstruction of facial cutaneous defects from skin cancer surgery is a commonly done procedure in the hands of many facial plastic surgeons. Excellent surgical technique should always be employed to reduce the risk of a poor result. However, complications do occur and can be devastating for both the patient and surgeon. We review a range of postoperative management options, and the evidence for each modality, so that reconstructive surgeons can stay up to date on current literature.

show abstract

Effects of Nitroglycerin Ointment on Mastectomy Flap Necrosis in Immediate Breast Reconstruction

Abstract: Therapeutic, I.

Cited by 70 publications

References 34 publications

Efficacy and safety of topical nitroglycerin in the prevention of mastectomy flap necrosis: a systematic review and meta-analysis

Efficacy and safety of topical nitroglycerin in the prevention of mastectomy flap necrosis: a systematic review and meta-analysis

Mastectomy skin flap necrosis: challenges and solutions

Management of Complications from Skin Cancer Reconstruction

Contact Info

Product

Resources

About