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Nitroglycerin Ointment for Reducing the Rate of Mastectomy Flap Necrosis in Immediate Implant-Based Breast Reconstruction

Turin, Sergey Y., M.D.; Li, Daniel D., B.S.; Vaca, Elbert E., M.D.; Fine, Neil, M.D.

Erratum

The authors of the September 2018 Breast article entitled “Nitroglycerin Ointment for Reducing the Rate of Mastectomy Flap Necrosis in Immediate Implant-Based Breast Reconstruction” ( Plast Reconstr Surg . 2018;142:264e–270e), wish to make the following statement:

When nitroglycerin paste application is addressed throughout the article, the doses should refer to milligrams of nitroglycerin, not grams. There are instances in the Abstract and the Discussion where these are erroneously listed as grams. For clarity, the authors apply 15 mg of nitroglycerin on each mastectomy breast flap (for a total of 30 mg in bilateral cases), as compared to 45 mg per breast by Gdalevich et al. (Gdalevitch P, Van Laeken N, Bahng S, et al. Effects of nitroglycerin ointment on mastectomy flap necrosis in immediate breast reconstruction: a randomized controlled trial. Plast Reconstr Surg . 2015;135:1530). This corresponds, respectively, to 1 inch (2 inches for bilateral cases) as compared to 3 inches of Nitro-Bid (nitroglycerin 2% ointment) by the measure on the packet (E. Fougera & Co., a division of Nycomed U.S., Inc., Melville, N.Y.).

The authors apologize for the error.

Plastic and Reconstructive Surgery. 142(5):1400, November 2018.

Plastic and Reconstructive Surgery: September 2018 - Volume 142 - Issue 3 - p 264e-270e
doi: 10.1097/PRS.0000000000004633
Breast: Original Articles
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Discussion

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.

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Chicago, Ill.

From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine.

Received for publication October 25, 2017; accepted March 8, 2018.

Presented at the 56th Annual Scientific Meeting of the Midwest Association of Plastic Surgeons, in Chicago, Illinois, April 15, 2017.

Disclosure:The authors declare that they had no financial interests, commercial associations, or conflicts of interest during the course of this study.

Sergey Y. Turin, M.D., Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street, Suite 19-250, Chicago, Ill. 60611, sergeyturin@gmail.com

Copyright © 2018 by the American Society of Plastic Surgeons