by Turin, Sergey Y.; Li,
Daniel D.; Vaca, Elbert E.; Fine, Neil
Background: Mastectomy
flap necrosis remains a challenging complication in immediate tissue expander
breast reconstruction. Nitroglycerin ointment has been shown to reduce the
incidence of mastectomy flap necrosis in a randomized controlled study, using
45 g per breast and treating one side only in bilateral cases. This study was
conducted to determine the efficacy of 15 g of nitroglycerin ointment per
breast, therefore permitting application to both breasts in cases of bilateral
mastectomy. Methods: A retrospective cohort study of patients undergoing
immediate tissue expander breast reconstruction performed by a single
reconstructive surgeon was conducted. The intervention cohort consisted of all
patients between June 10, 2015, and June 9, 2016 (94 patients, 158 breasts),
where 15 g of nitroglycerin ointment was routinely applied per breast. The
control cohort consisted of all patients from June 10, 2014, to June 9, 2015
(107 patients, 170 breasts), where nitroglycerin was not applied. All
complications were tracked, including minor wound healing problems. Results:
There was an overall 22 percent decreased incidence of mastectomy flap necrosis
in the nitroglycerin ointment cohort (47.5 percent versus 60.6 percent; p =
0.002), with a 44 percent reduction in full-thickness mastectomy flap necrosis
that trended toward statistical significance (9.5 percent versus 16.5 percent;
p = 0.06). On multivariate analysis, nitroglycerin application was
independently associated with a decrease in mastectomy flap necrosis or need
for mastectomy flap débridement. There was no significant difference in the
incidence of postoperative hypotension (3.8 percent versus 2.9 percent) or
headache among cohorts. Conclusion: Topical nitroglycerin ointment application
to mastectomy skin flaps at 15 g per breast is a cost-effective means of
decreasing the incidence of mastectomy flap necrosis in unilateral and
bilateral immediate tissue expander breast reconstruction. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
