Effects of dextran-40 on flap viability after modified radical mastectomy
Identifieur interne : 003694 ( Main/Merge ); précédent : 003693; suivant : 003695Effects of dextran-40 on flap viability after modified radical mastectomy
Auteurs : Baris Dogu Yildiz ; Barlas Sulu [Turquie]Source :
- The Canadian Journal of Plastic Surgery [ 1195-2199 ] ; 2013.
Abstract
Postoperative management of patients after modified radical mastectomy has evolved over the past decades. In the early postoperative period, wound complication rates were reported to be as high as 60%. Flap necrosis after modified radical mastectomy is a common problem encountered by surgeons. Various treatment strategies have been proposed in the literature but none have addressed the use of dextran-40.
To determine whether dextran-40 infusion improves skin flap viability after modified radical mastectomy.
Twenty-eight patients who underwent modified radical mastectomy were randomly assigned to receive dextran-40 or no dextran-40 intraoperatively after flap dissection. Patients were followed prospectively over a five-year period in a community hospital. The incidence of postmastectomy skin flap necrosis and prognosis of the necrotic area after dextran-40 infusion was observed.
Flap necrosis was observed in five (17.8%) patients. Hypertension and diabetes mellitus were found to be risk factors for the development of flap necrosis (P<0.05). Flap thickness and tension on the flaps were found to be related to flap necrosis. Six of seven patients with flap perfusion problems (ecchymosis or necrosis) underwent dextran-40 treatment and healed without graft replacement.
Dextran-40 treatment did not affect development of flap necrosis. However, if necrosis had already developed, the necrotic area of the skin flaps improved with dextran-40 treatment.
Url:
PubMed: 24431947
PubMed Central: 3891096
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PMC:3891096Le document en format XML
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<author><name sortKey="Yildiz, Baris Dogu" sort="Yildiz, Baris Dogu" uniqKey="Yildiz B" first="Baris Dogu" last="Yildiz">Baris Dogu Yildiz</name>
<affiliation><nlm:aff id="af1-cjps21083">Department of Surgery, Ankara Numune Training Hospital, Ankara;</nlm:aff>
<wicri:noCountry code="subfield">Ankara</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Sulu, Barlas" sort="Sulu, Barlas" uniqKey="Sulu B" first="Barlas" last="Sulu">Barlas Sulu</name>
<affiliation wicri:level="1"><nlm:aff id="af2-cjps21083">Kafkas University Faculty of Medicine, General Surgery, Kars, Turkey</nlm:aff>
<country xml:lang="fr">Turquie</country>
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<author><name sortKey="Yildiz, Baris Dogu" sort="Yildiz, Baris Dogu" uniqKey="Yildiz B" first="Baris Dogu" last="Yildiz">Baris Dogu Yildiz</name>
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<wicri:noCountry code="subfield">Ankara</wicri:noCountry>
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<author><name sortKey="Sulu, Barlas" sort="Sulu, Barlas" uniqKey="Sulu B" first="Barlas" last="Sulu">Barlas Sulu</name>
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<series><title level="j">The Canadian Journal of Plastic Surgery</title>
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<front><div type="abstract" xml:lang="en"><sec><title>BACKGROUND:</title>
<p>Postoperative management of patients after modified radical mastectomy has evolved over the past decades. In the early postoperative period, wound complication rates were reported to be as high as 60%. Flap necrosis after modified radical mastectomy is a common problem encountered by surgeons. Various treatment strategies have been proposed in the literature but none have addressed the use of dextran-40.</p>
</sec>
<sec><title>OBJECTIVE:</title>
<p>To determine whether dextran-40 infusion improves skin flap viability after modified radical mastectomy.</p>
</sec>
<sec><title>METHODS:</title>
<p>Twenty-eight patients who underwent modified radical mastectomy were randomly assigned to receive dextran-40 or no dextran-40 intraoperatively after flap dissection. Patients were followed prospectively over a five-year period in a community hospital. The incidence of postmastectomy skin flap necrosis and prognosis of the necrotic area after dextran-40 infusion was observed.</p>
</sec>
<sec><title>RESULTS:</title>
<p>Flap necrosis was observed in five (17.8%) patients. Hypertension and diabetes mellitus were found to be risk factors for the development of flap necrosis (P<0.05). Flap thickness and tension on the flaps were found to be related to flap necrosis. Six of seven patients with flap perfusion problems (ecchymosis or necrosis) underwent dextran-40 treatment and healed without graft replacement.</p>
</sec>
<sec><title>CONCLUSIONS:</title>
<p>Dextran-40 treatment did not affect development of flap necrosis. However, if necrosis had already developed, the necrotic area of the skin flaps improved with dextran-40 treatment.</p>
</sec>
</div>
</front>
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