Decoding the Mastectomy SKIN Score: An Evaluation of Its Predictive Performance in Immediate Breast Reconstruction.

Autor:	Hassan AM; From the Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine., Nguyen HT; McGovern Medical School, University of Texas Health Science Center at Houston., Elias AM; McGovern Medical School, University of Texas Health Science Center at Houston., Nelson JA; Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center., Coert JH; Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht., Mehrara BJ; Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center., Butler CE; Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center., Selber JC; Corewell Health.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2024 Jun 01; Vol. 153 (6), pp. 1073e-1079e. Date of Electronic Publication: 2023 Jun 07.
DOI:	10.1097/PRS.0000000000010817
Abstrakt:	Background: The skin ischemia and necrosis (SKIN) score was introduced to standardize the assessment of mastectomy skin flap necrosis (MSFN) severity and the need for reoperation. The authors evaluated the association between the SKIN score and the long-term postoperative outcomes of MSFN after mastectomy and immediate breast reconstruction. Methods: The authors conducted a retrospective cohort study of consecutive patients who developed MSFN after mastectomy and immediate breast reconstruction from January of 2001 to January of 2021. The primary outcome was breast-related complications after MSFN. Secondary outcomes were 30-day readmission, operating room (OR) débridement, and reoperation. Study outcomes were correlated with the SKIN composite score. Results: The authors identified 299 reconstructions in 273 consecutive patients with mean follow-up time of 111.8 ± 3.9 months. Most patients had a composite SKIN score of B2 (25.0%, n = 13), followed by D2 (17.3%) and C2 (15.4%). We found no significant difference in rates of OR débridement ( P = 0.347), 30-day readmission ( P = 0.167), any complication ( P = 0.492), or reoperation for a complication ( P = 0.189) based on the SKIN composite score. The composite skin score was a poor predictor of reoperation, with an area under the curve of 0.56. A subgroup analysis in patients who underwent implant-based reconstruction revealed no difference in rates of OR débridement ( P = 0.986), 30-day readmission ( P = 0.530), any complication ( P = 0.492), or reoperation for a complication ( P = 0.655) based on the SKIN composite score. Conclusions: The SKIN score was a poor predictor for postoperative MSFN outcomes and reoperation. An individualized risk-assessment tool that incorporates the anatomic appearance of the breast, imaging data, and patient-level risk factors is needed. Clinical Question/level of Evidence: Risk, IV. (Copyright © 2023 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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