NPWTi proves to be an efficient treatment option for abdominal wall wound dehiscence with mesh exposure, compared to CWT. More trials aimed to optimize treatment protocols will lead to an additional increase in NPWTi efficiency. In addition, to generalize our results, further studies with larger samples would be necessary.
BackgroundIn the practice of breast augmentation and reconstruction, implant irrigation with various solutions has been widely used to prevent infection and capsular contracture, but to date, there is no consensus on the optimal protocol to use. Recently, application of povidone iodine (PI) for 30 min has shown in vitro to be the most effective irrigating formula in reducing contamination in smooth breast implants. However, as 30 min is not feasible intraoperatively, it is necessary to determine whether shorter times could be equally effective as well as to test it in both smooth and textured implants.MethodsWe tested the efficacy of 10% PI at 1′, 3′, and 5′ against biofilms of 8 strains (2 ATCC and 6 clinical) of Staphylococcus spp. on silicone disks obtained from Mentor® and Polytech® implants of different textures. We analyzed the percentage reduction of cfu counts, cell viability and bacterial density between treatment (PI) and control (sterile saline, SS) groups for each time of application. We consider clinical significance when > 25% reduction was observed in cell viability or bacterial density.ResultsAll textured implants treated with PI at any of the 3 exposure times reduced 100% bacterial load by culture. However, none of the implants reached enough clinical significance in percentage reduction of living cells. Regarding bacterial density, only 25–50 μm Polytxt® Polytech® implants showed significant reduction at the three PI exposure times.ConclusionPI is able to inhibit bacterial growth applied on the surface of breast implants regardless of the exposure time. However, no significant reduction on living cells or bacterial density was observed. This lack of correlation may be caused by differences in texture that directly affect PI absorption.
Background: Pyoderma gangrenosum (PG) is a rare cutaneous ulcerative disease that does not respond to antibiotics and worsens with surgical manipulation. This is the first report in the literature revealing that this disease complicates total microsurgical breast reconstruction associated with the transfer of free lymph nodes. Case Report: We report the case of a female patient who underwent left-breast microsurgical reconstruction with a deep inferior epigastric perforator (DIEP) flap and simultaneous transfer of vascularized free lymph nodes for the surgical treatment of secondary left upper-limb lymphedema, and who developed a severe PG of both the skin of the flap and the donor zone on postoperative day 7. After exclusion of other etiologies, treatment with high-dose corticosteroids and topical zinc sulfate was initiated. The flap was salvaged and breast cancer-related lymphedema (BCRL) surgery was definitively effective despite the PG. Conclusions: PG should be considered in the differential diagnosis of progressive cutaneous ulcers following surgical interventions, once infectious and ischemic etiologies have been excluded. Early initiation of immunosuppressive treatment can lead to preservation of the initial flap and function of the transferred lymph nodes in the case of microsurgical breast reconstruction with associated lymph node transfer.
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