Skin banking: Treatment option for native skin necrosis following skin‐sparing mastectomy and previous breast irradiation

Reichl, Heike; Hladik, Michaela; Wechselberger, Gottfried

doi:10.1002/micr.20871

Cited by 9 publications

(14 citation statements)

References 18 publications

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“…Where the risk of MSFN is considered to be very high during mastectomy, other operative management strategies may involve the use of skin banking104 or skin grafts, which may be split or full thickness, using redundant abdominal dog ear tissue, for example 9…”

Section: Resultsmentioning

confidence: 99%

“…Skin banking is a method of delayed inset of the flap – the autologous tissue is not de-epithelialized at the time of primary reconstruction and is placed into the subcutaneous pocket, providing options where there is questionable viability of skin flaps, should native mastectomy skin necrose 4,104. However, this does commit the patient to a second operation and therefore should perhaps be reserved sparingly for patients with multiple risk factors, where it is considered very likely that they will experience skin necrosis.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Mastectomy skin flap necrosis: challenges and solutions

Robertson¹,

Jeevaratnam²,

Agrawal³

et al. 2017

BCTT

102

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Mastectomy skin flap necrosis: challenges and solutions

Robertson¹,

Jeevaratnam²,

Agrawal³

et al. 2017

BCTT

102

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show abstract

“…Since the introduction of the skin-banking technique, it has been used with some frequency [ 13 14 15 16 17 ]. However, to the best of our knowledge, the risk factors for this procedure and its outcomes have been not been previously studied with an algorithmic approach.…”

Section: Introductionmentioning

confidence: 99%

Nipple-Areola Complex Necrosis after Nipple-Sparing Mastectomy with Immediate Autologous Breast Reconstruction

et al. 2015

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BackgroundAutologous or implant-based breast reconstruction after nipple-sparing mastectomy is increasingly preferred worldwide as a breast cancer treatment option. However, postoperative nipple-areola complex (NAC) necrosis is the most significant complication of nipple-sparing mastectomy. The purpose of our study was to identify the risk factors for NAC necrosis, and to describe the use of our skin-banking technique as a solution.MethodsWe reviewed cases of immediate autologous breast reconstruction after nipple-sparing mastectomy at our institution between June 2005 and January 2014. The patients' data were reviewed and the risk of NAC necrosis was analyzed based on correlations between patient variables and NAC necrosis. Moreover, data pertaining to five high-risk patients who underwent the donor skin-banking procedure were included in the analysis.ResultsEighty-five patients underwent immediate autologous breast reconstruction after nipple-sparing mastectomy during the study period. Partial or total NAC necrosis occurred in 36 patients (43.4%). Univariate analysis and binary regression modeling found that body mass index, smoking history, radiation therapy, and mastectomy volume were significantly associated with NAC necrosis. Of the 36 cases of NAC necrosis, 31 were resolved with dressing changes, debridement, or skin grafting. The other five high-risk patients underwent our prophylactic skin-banking technique during breast reconstruction surgery.ConclusionsNAC necrosis is common in patients with multiple risk factors. The use of the skin-banking technique in immediate autologous breast reconstruction is an attractive option for high-risk patients. Banked skin can be used in such cases without requiring additional donor tissue, with good results in terms of aesthetic and reconstructive outcomes.

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“…Mastectomy flap necrosis results in significant economic burden to the healthcare system and has a psychological and physical impact on the patient as they deal with ongoing management . As such, strategies for preventing necrosis—including leaving thicker mastectomy flaps, delicate handling of tissues, and use of topical nitroglycerin paste—have been investigated . One important factor to consider is mastectomy technique.…”

Section: Introductionmentioning

confidence: 97%

“…11 As such, strategies for preventing necrosis-including leaving thicker mastectomy flaps, delicate handling of tissues, and use of topical nitroglycerin paste-have been investigated. [12][13][14] One important factor to consider is mastectomy technique. A common method involves use of electrocautery to dissect out the breast tissue, which has been postulated to affect skin flap vascularity.…”

Section: Introductionmentioning

confidence: 99%

Mastectomy flap necrosis after nipple‐sparing mastectomy and immediate implant‐based reconstruction: An evaluation of tumescence and sharp dissection technique on surgical outcomes

Knowles

Brackstone

et al. 2019

Breast J

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Nipple‐sparing mastectomy (NSM) with immediate implant‐based reconstruction has better esthetic outcomes and improved patient satisfaction, in addition to being oncologically safe. A known complication of NSM is skin flap necrosis. The use of tumescence and sharp dissection may decrease this complication compared to the standard NSM technique using electrocautery. This is a retrospective review of patients who underwent a NSM between 2014 and 2017 at a regional cancer center. Tumescence with sharp dissection was compared to electrocautery. The primary outcome was skin flap necrosis. The secondary outcomes were operative time and management of the complication. A total of 62 patients underwent a NSM with 116 breasts being operated on. Full‐thickness necrosis occurred more frequently in the standard electrocautery group (12.8%) compared to the tumescence and sharp dissection group (1.3%; P = 0.02). Partial‐thickness necrosis also occurred more frequently in the standard group (33.3%) compared to the sharp dissection group (13.0%; P = 0.01). The operative time was significantly shorter in the sharp dissection group with the mean (SD) time being 183.5 (48.9) minutes compared to the standard electrocautery group at 202.9 (33.8) minutes (P = 0.03). NSM using tumescence and sharp dissection have a lower rate of the complications of partial‐ and full‐thickness necrosis. Shorter operative time was also seen with the tumescent technique.

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Skin banking: Treatment option for native skin necrosis following skin‐sparing mastectomy and previous breast irradiation

Cited by 9 publications

References 18 publications

Mastectomy skin flap necrosis: challenges and solutions

Mastectomy skin flap necrosis: challenges and solutions

Nipple-Areola Complex Necrosis after Nipple-Sparing Mastectomy with Immediate Autologous Breast Reconstruction

Mastectomy flap necrosis after nipple‐sparing mastectomy and immediate implant‐based reconstruction: An evaluation of tumescence and sharp dissection technique on surgical outcomes

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