Mastectomy skin flap necrosis: challenges and solutions

Stuart A Robertson,1 Johann A Jeevaratnam,2 Avi Agrawal,2 Ramsey I Cutress,3,4 1Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry, 2Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, 3Department of Breast Surgery, University Hospi...

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Autores principales:	Robertson SA, Jeevaratnam JA, Agrawal A, Cutress RI
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	mastectomy skin flap necrosis; mastectomy; skin flap necrosis; skin flap; necrosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/b62240dc64f64363bc9665614ce0225d
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spelling	oai:doaj.org-article:b62240dc64f64363bc9665614ce0225d2021-12-02T02:45:24ZMastectomy skin flap necrosis: challenges and solutions1179-1314https://doaj.org/article/b62240dc64f64363bc9665614ce0225d2017-03-01T00:00:00Zhttps://www.dovepress.com/mastectomy-skin-flap-necrosis-challenges-and-solutions-peer-reviewed-article-BCTThttps://doaj.org/toc/1179-1314Stuart A Robertson,1 Johann A Jeevaratnam,2 Avi Agrawal,2 Ramsey I Cutress,3,4 1Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry, 2Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, 3Department of Breast Surgery, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, 4Somers Cancer Research UK Centre, Southampton General Hospital Southampton, UK 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. Keywords: mastectomy, flap, necrosis, complication, breast surgeryRobertson SAJeevaratnam JAAgrawal ACutress RIDove Medical Pressarticlemastectomy skin flap necrosis; mastectomy; skin flap necrosis; skin flap; necrosisNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBreast Cancer: Targets and Therapy, Vol Volume 9, Pp 141-152 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	mastectomy skin flap necrosis; mastectomy; skin flap necrosis; skin flap; necrosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	mastectomy skin flap necrosis; mastectomy; skin flap necrosis; skin flap; necrosis Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Robertson SA Jeevaratnam JA Agrawal A Cutress RI Mastectomy skin flap necrosis: challenges and solutions
description	Stuart A Robertson,1 Johann A Jeevaratnam,2 Avi Agrawal,2 Ramsey I Cutress,3,4 1Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry, 2Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, 3Department of Breast Surgery, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, 4Somers Cancer Research UK Centre, Southampton General Hospital Southampton, UK 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. Keywords: mastectomy, flap, necrosis, complication, breast surgery
format	article
author	Robertson SA Jeevaratnam JA Agrawal A Cutress RI
author_facet	Robertson SA Jeevaratnam JA Agrawal A Cutress RI
author_sort	Robertson SA
title	Mastectomy skin flap necrosis: challenges and solutions
title_short	Mastectomy skin flap necrosis: challenges and solutions
title_full	Mastectomy skin flap necrosis: challenges and solutions
title_fullStr	Mastectomy skin flap necrosis: challenges and solutions
title_full_unstemmed	Mastectomy skin flap necrosis: challenges and solutions
title_sort	mastectomy skin flap necrosis: challenges and solutions
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/b62240dc64f64363bc9665614ce0225d
work_keys_str_mv	AT robertsonsa mastectomyskinflapnecrosischallengesandsolutions AT jeevaratnamja mastectomyskinflapnecrosischallengesandsolutions AT agrawala mastectomyskinflapnecrosischallengesandsolutions AT cutressri mastectomyskinflapnecrosischallengesandsolutions
_version_	1718402185497149440

Mastectomy skin flap necrosis: challenges and solutions

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