ABSTRACT
BACKGROUND: Nipple sparing mastectomy (NSM) is an accepted surgical approach in selected breast cancer and prophylactic mastectomy, nevertheless post-mastectomy skin necrosis is one of the frequent complications. This study aimed to analyze the factors that may lead to skin necrosis after NSM. PATIENTS AND METHODS: From May 2010 to July 2010, we prospectively registered 50 consecutive NSM from 45 patients. There were 40 mastectomies for cancer, and 10 prophylactic mastectomies. The various patient's and surgical factors were registered during pre-, intra- and postoperative period. RESULTS: No total necrosis of the nipple areola complex (NAC) was observed. There were thirteen cases with partial necrosis (26.0%) of the areola or the adjacent skin. All these necrosis were partial both for the surface and the thickness. Surgical debridement was performed in 9 (18.0%) cases. The significant risk factors are smoking, young age, type of incision and NAC involvement with areola flap thickness less than 5 mm. CONCLUSION: NSM should be done with high caution in smokers. Young patients, periareolar incision and superior circumareolar incision have also a higher risk of necrosis. We recommend keeping areolar flap thickness more than 5 mm in areola region.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Mastectomy, Subcutaneous/methods , Nipples , Surgical Flaps/blood supply , Adult , Aged , Breast Neoplasms/prevention & control , Cohort Studies , Female , Follow-Up Studies , Humans , Immunohistochemistry , Mammaplasty/methods , Mastectomy, Subcutaneous/adverse effects , Middle Aged , Necrosis/pathology , Necrosis/surgery , Neoplasm Invasiveness/pathology , Neoplasm Staging , Patient Selection , Postoperative Complications/pathology , Predictive Value of Tests , Primary Prevention/methods , Prospective Studies , Risk Assessment , Statistics, Nonparametric , Treatment Outcome , Wound Healing/physiologyABSTRACT
The clinical management of the elective midtrimester abortion continues to be unsatisfactory as judged by either national mortality or morbidity rates. This report documents the results of a randomized series of 19 midtrimester abortions induced by either intra-amniotic hyperosmolar urea and 5 mg. of prostaglandin F2alpha (PGF2alpha) or intra-amniotic hyperosmolar urea alone. Pertinent clinical characteristics and biochemical determinations were compared between these two groups. A series of 150 patients were then treated with urea and 5 mg. of PGF2alpha. The clinical results of this series of patients are presented and compared with a previous group who had urea and 10 mg. of PGF2alpha. These studies demonstrate that 5 mg. of PGF2alpha with 80 Gm. of urea achieves injection-abortion intervals that are less than 24 hours.
PIP: Intraamniotic urea and prostaglandin F2 alpha (PGF2a) combinations for midtrimester abortion were compared in the following series: 8 multiparas given 80 gm urea in 135 ml 5% dextrose and 5 mg PGF2a, 8 multiparas given urea only, 150 nulliparas and multiparas given urea and 5 mg PGF2a, and 180 given urea and 10 mg PGF2a. In the 2 small series, there was 1 failure in the urea group. Mean abortion times were 28.8 hours after urea, 18.3 hours after urea and 5 mg PGF2a, and 16.3 and 17.5 hours in the 2 large series given urea and 10 and 5 mg PGF2a, respectively. Urea caused loss of fetal heart tones within 2 hours, had a half-life in amniotic fluid of 3 hours, caused a low frequency of late emesis, and resulted in short-lived burning or warm sensation in 1 case of accidental intravascular injection. Oxytocin infusions were used frequently for failure to abort within 24 hours, or lack of uterine contractions after membrane rupture or incomplete abortion. PGF2a accelerated uterine tone, frequency, and integrated uterine pressure over the values measured in subjects given urea only.
Subject(s)
Abortion, Induced , Prostaglandins F/administration & dosage , Urea/administration & dosage , Adult , Amnion , Blood Urea Nitrogen , Female , Humans , Osmolar Concentration , Pregnancy , Pregnancy Trimester, Second , Prostaglandins F/adverse effects , Prostaglandins F/therapeutic use , Time Factors , Urea/adverse effects , Urea/therapeutic use , alpha-Fetoproteins/metabolismABSTRACT
The relationship between endogenous prostaglandin (PG) production and uterine activity was studied in hyperosmolar urea induced abortion patients. Polygraphic recordings of intraamniotic pressure were obtained at periodic intervals following intraamniotic injection of 80 gm urea. At 0, 0.25, 1, 4 and 8 hours amniotic fluid and blood samples were obtained for PGE, PGF and 13,14-dihydro-15-keto-prostaglandin of abortion. In eight patients studied, uterine tone was elevated by 0.25 hour although no rhythmic contractions were observed by 1 hour. At 4 hours, amniotic fluid PGF concentration increased significantly (P less than .01) over the pre-injection value and continued to increase at 8 hours. Amniotic fluid PGE, PGFM and all plasma PG's showed no change during the 8 hour period following urea administration. At time of abortion the plasma PGFM concentration was significantly. At time of abortion the injection (238 +/- 54.4 vs. 86.7 +/- 7.3 pg/ml). There was no significant concentrations. In the present study, there is no evidence that increased prostaglandin production precedes urea induced contractions. The possible role of PG's in uterine contractions is discussed.
