| Problem: The effect of estrogen and the selective estrogen receptor modulator, tamoxifen, on wound healing as applied specifically to autologous tissue transfer with skin flaps is not fully understood. Methods: Articles were obtained using PubMed via the Weill Cornell Medical College library and the online medical resource UpToDate. Articles more than 5 years old were generally excluded, and those chosen were assessed for topic relevance based on their abstract and/or the article in its entirety. Results: A total of 92 articles were retrieved using the search term combinations: "estrogen" + "flaps," "estrogen" + "cutaneous wound healing", and "tamoxifen" + "flaps". Of these, 69 were excluded based on date and topic relevance, and a total of 23 articles were pooled for analysis. Conclusions: This literature review focuses on 9 articles that look specifically at the role of estrogen and/or tamoxifen on skin flaps. All of the experimental studies reviewed here support the idea that stimulation of estrogen-mediated pathways is beneficial to skin flap survival. However, there is mixed literature on tamoxifen's effect on skin flap survival. A definitive recommendation about its use during autologous breast reconstruction based on the current collection of retrospective reviews does not exist. From this literature review, a proposal for a randomized controlled trial has been derived with the aim of providing level I evidence to help inform guidelines for tamoxifen therapy during breast reconstruction with abdominally based free flaps. |
