title: Local heat preconditioning in skin sparing mastectomy: a pilot study.
abstract: BACKGROUND
  Experimental data has shown an association with a reduction of flap necrosis after local heat-application to a supraphysiological level resulting from the up-regulation of heat shock proteins, such as HSP-32. The proteins maintained capillary perfusion and increased tissue tolerance to ischaemia. The purpose of this translational study was to evaluate the effect of local heat preconditioning before skin sparing mastectomy and immediate breast reconstruction.
  
  
  METHODS
  A prospective non-randomised trial was performed from July 2009-April 2010. 50 consecutive patients at risk of skin flap necrosis (BMI >30, sternal-to-nipple distance>26 cm or breast size>C-cup) were included. Twenty-five patients were asked to heat-precondition their breast 24-h prior to surgery using a hot water bottle with a water temperature of 43 °C (thermometers provided), in three 30-min cycles interrupted by spontaneous cooling to room temperature. Skin flap necrosis was defined by the need for surgical debridement. LDI images were taken pre- and post-mastectomy to demonstrate an increase in tissue vascularity.
  
  
  RESULTS
  36% of women (n=25) without local heat-treatment developed skin flap necrosis, 12% developed skin flap necrosis in the treatment group, resulting in a 24% difference (n=25; p=0.047 (95%CI 1%-47%)). LDI scanning of the heated breast demonstrated an increase in vascularity compared to the contralateral non-heated breast. Median length of inpatient stay for treatment group was 4 days (95%CI(4, 7)), controls 8 days (95%CI(8, 9) (p=<0.001)).
  
  
  CONCLUSIONS
  The data suggests that in selected cases, local heat preconditioning is a simple and non-invasive method of reducing skin necrosis and length of hospital stay following skin sparing mastectomy.
  
  
  BACKGROUND
  ACTRN12612001197820.
  
  
  METHODS
  II.
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom. Electronic address: saahil47@gmail.com.
authors.forename: Saahil
authors.initials: S
authors.lastname: Mehta
authors.forename: Rachel
authors.initials: R
authors.lastname: Rolph
authors.forename: Victoria
authors.initials: V
authors.lastname: Cornelius
authors.forename: Yves
authors.initials: Y
authors.lastname: Harder
authors.forename: Jian
authors.initials: J
authors.lastname: Farhadi
mesh_terms: D000368:Aged; D001940:Breast / Q000098:blood supply; D005260:Female; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis; D010865:Pilot Projects; D057234:Preoperative Period; D011446:Prospective Studies; D012867:Skin / Q000473:pathology*
keywords: Complications; Preconditioning; Prevention; Skin necrosis; Skin sparing mastectomy