牵引法矫正先天性乳头内陷术后乳头皮肤微循环灌注量的研究

Nipple skin microcirculatory perfusion after congenitally inverted nipple correction surgery using a traction technique

目的牵引法矫正先天性乳头内陷,术后乳头皮肤微循环会出现不同程度血运障碍。用激光多普勒散斑血流仪测量手术后乳头皮肤微循环灌注量,验证不同等级血运障碍乳头皮肤微循环灌注量差异,探讨手术后乳头皮肤微循环灌注量变化趋势,以及健康女性乳头乳房皮肤微循环模式。方法2016年10月至2022年10月,北京协和医院整形外科对37例72侧女性先天性内陷乳头行钢丝矫正器牵引矫正术,手术组患者年龄21~51(27.4±1.8)岁。同期纳入34例65侧健康女性正常乳头作为对照组,年龄18~50(26.5±1.7)岁。2组均用激光多普勒散斑血流仪PeriCam PSI系统测量乳头、乳晕皮肤微循环灌注量。对照组测量1次,手术组在术后2、5 d、1个月重复测量3次。结果对照组乳头皮肤微循环灌注量(137.77±22.94),乳房皮肤微循环灌注量(68.94±10.43),乳头与乳房皮肤微循环灌注量比较,差异有统计学意义(t=-14.12,P<0.001)。手术组术后2 d乳头皮肤微循环灌注量(179.57±41.48),与对照组乳头皮肤微循环灌注量(137.77±22.94)相比,手术会导致术后乳头皮肤微循环灌注量显著增加,术后5 d乳头皮肤微循环灌注量降低(167.28±38.16),术后1个月时趋于正常(131.45±39.64)。当乳头出现皮肤破溃或部分坏死等血运障碍时,乳头皮肤微循环灌注量显著降低(118.63±58.66),术后乳头血运障碍分级获得数据支持。结论正常女性乳头皮肤微循环灌注量明显高于乳房皮肤微循环灌注量。手术会导致乳头皮肤微循环灌注量明显增加,术后发生血运障碍导致乳头皮肤破溃或局部坏死时,乳头皮肤微循环灌注量显著降低。乳头皮肤完整性可作为临床观察关键点,经术后换药处理,乳头皮肤破溃全部愈合,至1个月时乳头皮肤微循环灌注量恢复正常状态。

Objective The traction method for correcting congenital nipple inversion was observed to induce varying degrees of hemodynamic compromise in the nipple skin microcirculation after surgery.In this study,the laser Doppler scattering flowmetry was employed to measure the postoperative nipple skin microcirculation perfusion to verify the difference in nipple skin microcirculation perfusion with different grades of hemodynamic disorders.Furthermore,we aimed to describe the trend of postoperative nipple skin microcirculation perfusion and to elucidate the patterns of nipple breast skin microcirculation in healthy women.Methods From October 2016 to October 2022,the Department of Plastic and Reconstructive Surgery of Peking Union Medical College Hospital performed traction correction of 72 congenital inverted nipples using wire braces in 37 women.The age of the patients in the surgical group ranged from 21 to 51 years with a mean age of 27.4±1.8 years.Concurrently,the control group consisted of 65 normal nipples of 34 healthy women aged between 18 to 50 years(mean age 26.5±1.7 years).In both groups,nipple and areola skin microcirculatory perfusion was measured using a laser Doppler scatter flow meter PeriCam PSI system.The control group underwent a single measurement whereas the surgical group was evaluated three times postoperatively at two days,five days,and one month.Results In the control group,the mean value of nipple skin microcirculation perfusion was 137.77±22.94,significantly higher than that for breast skin,which stood at 68.94±10.43(t=-14.116,P<0.001).The mean value of nipple skin microcirculation perfusion in the surgical group was 179.57±41.48 at two days postoperatively,which resulted in a significant increase in postoperative nipple skin microcirculation perfusion compared to the control group nipple skin microcirculation perfusion(137.77±22.94),and a decrease in nipple skin microcirculation perfusion at five days postoperatively(167.28±38.16),which was normalized at one month postoperatively(131.45±39.64).Notably,instances of hemodynamic disturbances such as skin breakdown or partial necrosis,the nipple skin microcirculation perfusion were significantly reduced(118.63±58.66),supporting the postoperative nipple hemodynamic classification.Conclusions The nipple skin microcirculation perfusion in healthy female is significantly higher than breast skin microcirculation perfusion.Surgical interventions for correcting congenital inverted nipples markedly enhance nipple skin microcirculatory perfusion,though the perfusion rate is prone to reduction in the case of postoperative hemodynamic disorders,manifesting as nipple skin breakdown or localized necrosis.The integrity of nipple skin can be used as a crucial metric for clinical evaluation.Notably,following postoperative dressing changes,all instances of nipple skin breakdowns heal with the microcirculation perfusion values reverting to normal by one month.