title: Effects of dextran-40 on flap viability after modified radical mastectomy.
abstract: BACKGROUND
  Postoperative management of patients after modified radical mastectomy has evolved over the past decades. In the early postoperative period, wound complication rates were reported to be as high as 60%. Flap necrosis after modified radical mastectomy is a common problem encountered by surgeons. Various treatment strategies have been proposed in the literature but none have addressed the use of dextran-40.
  
  
  OBJECTIVE
  To determine whether dextran-40 infusion improves skin flap viability after modified radical mastectomy.
  
  
  METHODS
  Twenty-eight patients who underwent modified radical mastectomy were randomly assigned to receive dextran-40 or no dextran-40 intraoperatively after flap dissection. Patients were followed prospectively over a five-year period in a community hospital. The incidence of postmastectomy skin flap necrosis and prognosis of the necrotic area after dextran-40 infusion was observed.
  
  
  RESULTS
  Flap necrosis was observed in five (17.8%) patients. Hypertension and diabetes mellitus were found to be risk factors for the development of flap necrosis (P<0.05). Flap thickness and tension on the flaps were found to be related to flap necrosis. Six of seven patients with flap perfusion problems (ecchymosis or necrosis) underwent dextran-40 treatment and healed without graft replacement.
  
  
  CONCLUSIONS
  Dextran-40 treatment did not affect development of flap necrosis. However, if necrosis had already developed, the necrotic area of the skin flaps improved with dextran-40 treatment.
authors.affiliation: Department of Surgery, Ankara Numune Training Hospital, Ankara;
authors.forename: Baris Dogu
authors.initials: BD
authors.lastname: Yildiz
authors.affiliation: Kafkas University Faculty of Medicine, General Surgery, Kars, Turkey.
authors.forename: Barlas
authors.initials: B
authors.lastname: Sulu
keywords: Breast cancer; Breast surgery; Flap circulation; Flap surgery; Mastectomy; Resection; Skin flap