Evaluating the effect of hyperbaric oxygen therapy to treat mastectomy skin flap ischemia in breast reconstruction: A single-institution retrospective analysis.

Abstract

Background: Mastectomy skin flap ischemia is a well-known postoperative complication following mastectomy and breast reconstruction. Hyperbaric oxygen therapy (HBOT) has shown promising results for reducing the adverse effects associated with mastectomy skin flap ischemia and associated necrosis; however, there is paucity of literature regarding the indications for HBOT following breast cancer surgery. This study aimed to assess HBOT efficacy in treating and mitigating complications from postoperative tissue ischemia. Secondarily, it explored how patient-related factors may impact the success of HBOT.

Methods: A retrospective analysis was conducted from January 2018 to October 2023. The study analyzed 23 patients at a single institution who were treated with HBOT for diagnosed skin flap ischemia following mastectomy and immediate breast reconstruction. Patient demographics, preoperative, and operative details were collected, as well as postoperative outcomes. The authors deemed HBOT a "success" if there were no major complications and a "failure" if there was ≥1 major complication reported within 6 months following the last HBOT treatment. Logistic regression modeled the odds of HBOT success as a function of patient characteristics.

Results: HBO was deemed a success in 15/23 patients (65 ​%) and a failure in 8/23 (35 ​%). Of the successes, 11 received immediate post-operative HBOT. Average age at surgery was 49 years, average BMI was 24, and average number of HBOT treatments was 11. Logistic regression analysis revealed that preceding minor complications and age both trended towards significance regarding their impact on HBO outcome. Odds of success decreased by 92 ​% in the presence of minor complications (OR ​= ​0.08; p ​< ​0.09) and increased by 15 ​% with every 1-year increase in age (OR ​= ​1.16; p ​< ​0.07) CONCLUSIONS: In this retrospective analysis, HBOT was successful in treating postoperative mastectomy skin flap ischemia and preventing major complications in the majority of patients. Notably, age at time of surgery and presence of minor complications were the only variables found to potentially impact the success of HBOT. Future studies on a larger scale are needed to better evaluate HBOT's therapeutic utility in mastectomy flap necrosis.