Risk Factors Of Skin Flap Necrosis After Modified Radical Mastectomy For Breast Cancer

BackgroundSkin flap necrosis is one of the most common complications after modified radical surgery for breast cancer.It occurs when the blood supply of the skin flap is insufficient to meet the metabolic needs.After the mild necrosis of the skin flap,the patients were given enhanced dressing change and blood-activating drugs,most of which could achieve good recovery effect.Moderate and severe skin flap necrosis will often prolong the hospitali-zation time of patients.When the necrotic area is large,skin grafting and other treatments are even needed,which not only increases the economic burden of patients,but also affects the postoperative aesthetics,and may delay the comprehensive treatment plan after breast cancer surgery.ObjectiveTo investigate the risk factors of skin flap necrosis after modified radical mastectomy for breast cancer.To provide reference basis for effective prevention of skin flap necrosis.MethodsRetrospective analysis was conducted on the data of 223 patients undergoing modified radical mastectomy for breast cancer admitted to the General Surgery Department of the First Affiliated Hospital of Xinxiang Medical University from May 2018 to March 2020,and divided them into skin flap necrosis group(47 cases)and non-flap necrosis group(176cases)according to whether skin flap necrosis occurred after surgery.From breast cancer onset age,disease area,Body Mass Index(BMI),menstrual status,hypertension,diabetes,tumor size,molecular classification,degree of differentiation,pathologic stage,operation time,intraoperative blood loss,the type of stitching,axillary lymph node cleaning the total volume,length of hospital stay,postoperative 3 d drainage for statistical analysis,measure-ment data to?x±s said,using t test.Enumeration data were expressed as rate andχ~2 test was used.Unconditional Logistic regression was used to analyze the risk factors.Results1.There were no statistically significant differences between the two groups in terms of basic clinical data such as onset age,menstrual status,hypertension,tumor size,molecular typing,degree of differentiation,pathological stage,operative time,intra-operative blood loss,number of axillary lymph nodes dissection,total postoperative drainage in 3 d(P>0.05).2.Unifactorial analysis showed that 47 of the 223 patients developed skin flap necrosis after surgery.The number of patients who used Spiral Pdo barb thread to suture skin flap was 43.2%,which was higher than 21.3%in the non-flap necrosis group.The tumors in the non-flap necrosis group were located in the medial region of 44.9%,which was higher than that in the flap necrosis group of 27.7%.BMI<24 kg/m~2 55.1%in non-flap necrosis group was lower than 74.5%in flap necrosis group.The proportion of diabetic patients in the non-flap necrosis group was 9.1%,which was lower than 23.4%in the flap necrosis group,and the differences between the two groups were statistically significant(P<0.05).3.The length of hospital stay in the non-flap necrosis group was 16.8±4.2 d,signifi-cantly lower than that in the flap necrosis group(19.2±3.8 d),and the difference between the two groups was statistically significant(P<0.05).4.Luminal A type 20.5%in the BMI<24 kg/m~2 group was higher than that in the BMI≥24 kg/m~2 group 17.6%,and there was no significant difference between the two groups(P>0.05).5.BMI≥24 kg/m~2 and the use of Spiral PDO barbed thread reduced the risk of skin flap necrosis,while the combination of diabetes and tumor location in the lateral region increased the risk of skin flap necrosis in modified radical mastectomy for breast cancer(OR=2.373,95%CI:1.104～5.099,P=0.027;OR=3.027,95%CI:1.333～6.873,P=0.008;OR=0.105,95%CI:0.105～0.593,P=0.002;OR=0.469,95%CI:0.221～0.996,P=0.049).ConclusionBMI<24 kg/m~2,tumor located in the lateral region,and diabetes mellitus were the risk factors for skin flap necrosis after modified radical resection of breast cancer.Spiral PDO barbed thread was used to suture skin flap for healing of surgical incision and reducing the incidence of skin flap necrosis.