Predicting Mastectomy Skin Flap Necrosis: A Systematic Review of Preoperative and Intraoperative Assessment Techniques.

Autor: Pagliara D; Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy. Electronic address: domenicopag@gmail.com., Schiavone L; Department of Surgery 'P.Valdoni', Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Roma, Italy., Garganese G; Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy., Bove S; Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy., Montella RA; Radiology Unit, Mater Olbia Hospital, Mater Olbia Hospital, Olbia, Italy., Costantini M; Radiology Unit, Mater Olbia Hospital, Mater Olbia Hospital, Olbia, Italy., Rinaldi PM; Radiology Unit, Mater Olbia Hospital, Mater Olbia Hospital, Olbia, Italy., Bottosso S; Department of Medical, Surgical and Health Sciences, Plastic Surgery Unit, University of Trieste, Ospedale di Cattinara, ASUGI, Trieste, Italy., Grieco F; Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari University Hospital Trust, Sassari, Italy., Rubino C; Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari University Hospital Trust, Sassari, Italy., Salgarello M; Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy., Ribuffo D; Department of Surgery 'P.Valdoni', Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Roma, Italy.
Jazyk: angličtina
Zdroj: Clinical breast cancer [Clin Breast Cancer] 2023 Apr; Vol. 23 (3), pp. 249-254. Date of Electronic Publication: 2023 Jan 04.
DOI: 10.1016/j.clbc.2022.12.021
Abstrakt: Mastectomy skin-flap necrosis (MSFN) is one of the most feared complications of immediate implant-based breast reconstruction (IIBR). Traditionally, mastectomy skin-flap viability was based only on surgeons' clinical experience. Even though numerous studies have already addressed the patients' risk factors for MSFN, few works have focused on assessing quality of breast envelope. This review investigates mastectomy's flap viability-assessment methods, both preoperative (PMFA) and intraoperative (IMFA), to predict MSFN and its sequalae. Between June and November 2022, we conducted a systematic review of Pubmed/MEDLINE and Cochrane electronic databases. Only English studies regarding PMFA and IMFA applied to IIBR were selected. The use of digital mammography, ultrasound, magnetic resonance imaging, and a combination of several methods before surgery was shown to be advantageous by several authors. Indocyanine performed better than other IMFA, however both thermal imaging and spectroscopy demonstrated novel and promising results. Anyway, the best prediction comes when preoperative and intraoperative values are combined. Particularly in prepectoral reconstruction, when mastectomy flaps are essential to determine a successful breast reconstruction, surgeons' clinical judgment is insufficient in assessing the risk of MSFN. Preoperative and intraoperative assessment techniques play an emerging key role in MSFN prediction. However, although there are several approaches to back up the surgeon's processing choice, there is still a dearth of pertinent literature on the subject, and more research is required.
Competing Interests: Disclosure The authors have stated that they have no conflicts of interest.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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