Radical mastectomy wound as a model for studies of human wound metabolism

Niinikoski, J; Jussila, Pekka; Vihersaari, Timo

doi:10.1016/s0002-9610(73)80094-7

Cited by 29 publications

(10 citation statements)

References 9 publications

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“…Mastectomy skin flaps are particularly vulnerable to poor circulation and hypoxia, exposing patients to a high risk of postoperative complications, specifically wound breakdown and flap necrosis [14,18-20]. Following immediate prosthetic-based reconstruction, the inflated expander may increase stress on the already tenuous microvascular circulation [8,15].…”

Section: Discussionmentioning

confidence: 99%

Synergistic Interactions with a High Intraoperative Expander Fill Volume Increase the Risk for Mastectomy Flap Necrosis

et al. 2013

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PurposeProsthetic-based breast reconstruction is performed with increasing frequency in the United States. Major mastectomy skin flap necrosis is a significant complication with outcomes ranging from poor aesthetic appearance to reconstructive failure. The present study aimed to explore the interactions between intraoperative fill and other risk factors on the incidence of flap necrosis in patients undergoing mastectomy with immediate expander/implant-based reconstruction.MethodsA retrospective review of 966 consecutive patients (1,409 breasts) who underwent skin or nipple sparing mastectomy with immediate tissue expander reconstruction at a single institution was conducted. Age, body mass index, hypertension, smoking status, premastectomy and postmastectomy radiation, acellular dermal matrix use, and application of the tumescent mastectomy technique were analyzed as potential predictors of flap necrosis both independently and as synergistic variables with high intraoperative fill. The following three measures of interaction were calculated: relative excess risk due to interaction, attributable proportion of risk due to interaction, and synergy index (SI).ResultsIntraoperative tissue expander fill volume was high (≥66.7% of the maximum volume) in 40.9% (576 of 1,409 breasts) of cases. The unadjusted flap necrosis rate was greater in the high intraoperative fill cohort than in the low fill cohort (10.4% vs. 7.1%, p=0.027). Multivariate logistic regression did not identify high intraoperative fill volume as an independent risk factor for flap necrosis (odds ratio 1.442, 95% confidence interval 0.973-2.137, p=0.068). However, four risk factors were identified that interacted significantly with intraoperative fill volume, namely tumescence, age, hypertension, and obesity. The SI, or the departure from additive risks, was largest for tumescence (SI, 25.3), followed by hypertension (SI, 2.39), obesity (SI, 2.28), and age older than 50 years (SI, 1.17).ConclusionIn the postmastectomy, hypovascular milieu, multiple risk factors decreasing flap perfusion interact with high intraoperative fill volume to cross a threshold and synergistically increase the risk of flap necrosis.

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Section: Discussionmentioning

confidence: 99%

Synergistic Interactions with a High Intraoperative Expander Fill Volume Increase the Risk for Mastectomy Flap Necrosis

et al. 2013

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“…Supplemental oxygen has been shown to reduce wound infection in some studies, 16,17 but not others, 38 including a large definitive trial. 39 Although oxygen reactive species are required during bactericidal activity, [40][41][42] excessive oxygen free radicals during hyperoxia may induce DNA and protein damage. 18,19 In the current study, we sought to clarify the effect of hyperoxia on DNA damage by including a third group of patients receiving 80% oxygen.…”

Section: Perioperative Medicinementioning

confidence: 99%

Leukocyte DNA Damage and Wound Infection after Nitrous Oxide Administration

et al. 2013

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“…This mechanism is compromised during surgical procedures because of a reduction in oxygen delivery to the tissues. All operations disrupt the vascular supply at the surgical site, causing the wound to become hypoxic compared with normal tissue [45] . Therefore, the supplemental administration of oxygen during surgical procedures may counterbalance the surgery-related hypoxia and reduces the risk for SSIs.…”

Section: Preoperative Hair Removalmentioning

confidence: 99%

Current Approaches for the Prevention of Surgical Site Infections

Florman¹,

Nichols²

2007

American J. of Infectious Diseases

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Surgical site infections (SSIs) are the most common type of nosocomial infection among surgical patients and are commonly caused by the patients' own microbial flora. The prevalence of SSI is a major concern because of the associated increase in the incidence of morbidity and mortality, length of hospitalization and cost of care for postoperative patients. Key factors that determine whether patients are at risk for developing SSI include the inherent potential contamination of the surgical site, the duration of the operation and the individual patient susceptibility. Preventive preoperative measures that can reduce the risk of SSIs include administration of antimicrobial prophylaxis, proper utilization of skin antiseptic agents for both the patient and the surgical team, proper patient preoperative hair removal and the policy of canceling elective procedures when remote skin, urinary or pulmonary infections occur. This paper will review the efficacy and safety of available antiseptic agents, as well as discuss patient-specific prevention strategies.

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Radical mastectomy wound as a model for studies of human wound metabolism

Cited by 29 publications

References 9 publications

Synergistic Interactions with a High Intraoperative Expander Fill Volume Increase the Risk for Mastectomy Flap Necrosis

Synergistic Interactions with a High Intraoperative Expander Fill Volume Increase the Risk for Mastectomy Flap Necrosis

Leukocyte DNA Damage and Wound Infection after Nitrous Oxide Administration

Current Approaches for the Prevention of Surgical Site Infections

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