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- 저자 : Francis Lovecchio (검색결과 1 건)
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Nima Khavanin,Sumanas Jordan,Francis Lovecchio,Neil A. Fine,John Kim 한국유방암학회 2013 Journal of breast cancer Vol.16 No.4
Purpose: Prosthetic-based breast reconstruction is performedwith increasing frequency in the United States. Major mastectomyskin flap necrosis is a significant complication with outcomesranging from poor aesthetic appearance to reconstructivefailure. The present study aimed to explore the interactionsbetween intraoperative fill and other risk factors on the incidenceof flap necrosis in patients undergoing mastectomy with immediateexpander/implant-based reconstruction. Methods: A retrospectivereview of 966 consecutive patients (1,409 breasts) whounderwent skin or nipple sparing mastectomy with immediatetissue expander reconstruction at a single institution was conducted. Age, body mass index, hypertension, smoking status,premastectomy and postmastectomy radiation, acellular dermalmatrix use, and application of the tumescent mastectomy techniquewere analyzed as potential predictors of flap necrosis bothindependently and as synergistic variables with high intraoperativefill. The following three measures of interaction were calculated:relative excess risk due to interaction, attributable proportionof risk due to interaction, and synergy index (SI). Results: Intraoperativetissue expander fill volume was high (≥66.7% of themaximum volume) in 40.9% (576 of 1,409 breasts) of cases. Theunadjusted flap necrosis rate was greater in the high intraoperativefill cohort than in the low fill cohort (10.4% vs. 7.1%, p=0.027). Multivariate logistic regression did not identify high intraoperativefill 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 interactedsignificantly with intraoperative fill volume, namely tumescence,age, hypertension, and obesity. The SI, or the departure from additiverisks, was largest for tumescence (SI, 25.3), followed byhypertension (SI, 2.39), obesity (SI, 2.28), and age older than 50years (SI, 1.17). Conclusion: In the postmastectomy, hypovascularmilieu, multiple risk factors decreasing flap perfusion interactwith high intraoperative fill volume to cross a threshold and synergisticallyincrease the risk of flap necrosis.
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