Can A Triangular Skin Flap Decrease T- Junction Dehiscence In Breast Reduction?
Humza Y. Saleem, MD, Jamie L. Kaplan, MD, Amer Mujkanovic, MD, Antonio J. Forte, MD PhD, Brian D. Rinker, MD.
Mayo Clinic, Jacksonville, FL, USA.
PURPOSE: The most common complication of a Wise pattern breast reduction is dehiscence of the wound at the inverted T junction. The inverted T-Junction, where the vertical and horizontal suture lines meet, has the greatest tension when compared to other aspects of the wound and is therefore prone to complication. A triangular skin flap (TSF) can decrease tension over the inverted T-junction and thus potentially decrease dehiscence rates in patients.
METHODS: A retrospective chart review was performed to identify adults (≥18 years) undergoing Wise pattern breast reductions between 2017 and 2020 by two surgeons with varying techniques of closure - with TSF vs traditional closure (TC). Patient demographics, etiology, type of closure, risk factors and complications were all analyzed. RESULTS: A total of 75 patients underwent Wise pattern breast reduction, of these 47 patients had closure with a TSF. The average age (TC=49, TSF=48, P>0.05), BMI (TC=34.5, TSF= 31.7, P>0.05) and size of breast reduction (TCF=783g, TSF= 574g, P>0.05) were similar in both cohorts. When compared with a TC, patients with a TSF were less likely to have a T-junction dehiscence (TC=11, TSF=6, P=0.02, OR = 0.271 CI95% 0.073 - 0.76). Median follow up was 130 days (Range 8 - 679 days).
CONCLUSION: Wound dehiscence in breast reduction is a common problem. A simple triangular skin flap may hold the key to reducing T-junction dehiscence in this patient population.
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