乳腺癌术后皮瓣坏死原因和预防措施探讨

Causes and prevention of skin flap necrosis after breast cancer surgery

目的:探讨乳腺癌术后皮瓣坏死的原因及其防治措施。方法:回顾性分析32例乳腺癌患者的临床资料,分析不同手术切口、皮瓣厚度、皮瓣张力、引流方式患者术后皮瓣发生坏死情况。结果:32例乳腺癌患者中,术后皮瓣坏死6例(18.75%),皮瓣坏死与切口选择、皮瓣厚度、皮瓣张力、单或双管引流有关,采用横形切口、厚皮瓣、低张力皮瓣、双管引流者的皮瓣坏死发生率明显低于纵斜形切口、薄皮瓣、高张力皮瓣和单管引流者,差异有统计学意义(P均<0.05)。结论:乳腺癌术后皮瓣坏死原因是多方面的,皮瓣供血不足是术后皮瓣坏死的根本原因。合理选择手术切口,适当厚度的皮瓣,无张力缝合,保护皮瓣血运,术后双管引流等是防治皮瓣坏死的关键措施。

Objective： To investigate the causes and prevention of skin flap necrosis after breast cancer surgery. Methods： Clinical data of 32 patients with breast cancer were retrospectively analyzed, including operative incision, thickness of flap, flap tension, drainage method, and necrosis status. Results-There were 6 cases with skin flap necrosis （18.75%）. Skin flap necrosis was related with the incision, flap thickness and flap tension, and drainage by single or double tube（P〈0.05）. Oonclusions： There are various causes for skin flap necrosis after breast cancer surgery. Insufficient blood supply is the fundamental cause. Reasonable incision, proper thickness of skin flap, no tension suture, sufficient blood supply of skin flap, and double tube drainage can help in control of skin flap necrosis.