Abstract
Flap necrosis is a common complication after mastectomy, and nitroglycerin (NTG) ointment has been used successfully to treat it. However, it is not clear whether topical NTG can completely prevent the occurrence of flap necrosis after breast cancer surgery, and it is also unclear whether this treatment may cause side effects. Three randomized controlled trials (RCTs) and two retrospective cohort studies (RCSs) were included in our investigation. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that NTG significantly reduced the rates of mastectomy flap necrosis, full-thickness flap necrosis, and debridement as well as the rate of early complications other than flap necrosis. However, there was no significant difference in drug-related adverse reactions, explantation, superficial flap necrosis, infection, hematoma or seroma between the NTG and placebo groups.
Highlights
Flap necrosis is a common complication after mastectomy, and nitroglycerin (NTG) ointment has been used successfully to treat it
The rate may continue to rise as nipple-sparing mastectomy and immediate breast reconstruction (IBR) become more prevalent in young breast cancer patients, there is some evidence that the risks of flap necrosis and implant failure are higher in IBR than in mastectomy alone[10]
Ricci reported that substituting topical NTG for papaverine to treat vasospasm during a shortage was not associated with an increased rate of flap loss or return to the operating room, making NTG a safe alternative to papaverine after breast reconstruction[18]
Summary
Flap necrosis is a common complication after mastectomy, and nitroglycerin (NTG) ointment has been used successfully to treat it. It is not clear whether topical NTG can completely prevent the occurrence of flap necrosis after breast cancer surgery, and it is unclear whether this treatment may cause side effects. Three randomized controlled trials (RCTs) and two retrospective cohort studies (RCSs) were included in our investigation. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Many studies have shown that NTG treatment may improve the survival of random-pattern skin flaps by increasing local blood flow[11,12,13]. Some studies have suggested that NTG cannot reduce the rate of debridement after IBR19–21. Another purpose of this article is to determine whether NTG can reduce the flap debridement rate after mastectomy
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