by Siotos, Charalampos;
Aston, Jeffrey W.; Euhus, David M.; Seal, Stella M.; Manahan, Michele A.;
Rosson, Gedge D
Background:
Postoperative skin necrosis in surgical patients is costly to hospitals and
health care providers. Tumescent dissection technique is commonly used in
mastectomy and immediate breast reconstruction, as it helps reduce blood loss;
however, it may increase the risk of mastectomy skin flap necrosis. In this
context, the authors have conducted a systematic review of the literature to
perform a meta-analysis of the relationship between tumescent technique in
mastectomy with or without breast reconstruction and complication rates.
Methods: The
authors screened the PubMed (1966 to 2016), Scopus (2004 to 2016), Embase (1966
to 2016), and Web of Science (1964 to 2016) databases for relevant articles
through March 30, 2017. The authors included studies on the use of tumescent
technique in the context of mastectomy with or without immediate breast
reconstruction. The primary outcome the authors evaluated was the rate of skin
flap necrosis; the secondary outcomes were the rates of breast hematomas and
infections. Because of the heterogeneity of the studies, the authors performed
a meta-analysis using the random effects model.
Results: After
screening, the authors evaluated five studies including 3982 mastectomies.
Mastectomies performed under the preoperative application of tumescent solution
had statistically higher rates of skin flap necrosis overall (p = 0.03) and
major (p < 0.01) and minor skin necrosis (p = 0.03). However, the rates of
hematoma and infection were not correlated with the use of tumescent technique.
Conclusions: The
authors’ systematic review of the literature provides a better understanding of
the consequences of the application of tumescent technique in mastectomy. The
authors’ findings suggest that tumescent technique may increase the risk of
skin necrosis in mastectomy with or without breast reconstruction.
