Salvaging the Unsalvageable: Negative Pressure Wound Therapy for Severe Infection of Prosthetic Breast Reconstruction

Meybodi, Farid; Sedaghat, Negin; Elder, Elisabeth; French, James; Adams, Kristian; Hsu, Jeremy; Kanesalingam, Kavitha; Brennan, Meagan

doi:10.1097/gox.0000000000003456

Cited by 4 publications

(9 citation statements)

References 33 publications

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“…Many other protocols also involve extended postoperative oral antibiotic regimens between 3 18 and 6 weeks 23 or more following operative salvage. Although all of our patients completed outpatient antibiotic regimens, none extended past 14 days.…”

Section: Discussionmentioning

confidence: 99%

“…changes. 9 , 15 , 16 , 18 Cheong et al reported a protocol in which V.A.C. VERAFLO was inserted for a total of 7 days before removal and placement of permanent implants; this week-long therapy involved foam changes in the operating room every 2 days.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, our average length of stay (4.43 days) is notably shorter when compared with other similar studies, which report an average length of stay from 7 to 12 days (see Table 5 ). 15 , 16 , 18 …”

Section: Discussionmentioning

confidence: 99%

“…28 Meybodi et al changed the NPWTi-d dressings up to seven times in each patient. 15,18 As mentioned, our patients underwent an average of 2 days, 7 hours of NPWTi-d therapy, with no interval washouts or V.A.C. changes.…”

Section: No Vac Changes In Single Application Npwti-dmentioning

confidence: 98%

“…Constantine described successful breast prosthesis salvage with use of NPWTi-d in a late mycobacterial infection after mastectomy, 17 and Meybodi et al published a protocol with an 83% salvage rate of severe peri-prosthetic infections. 18 These authors showed successful salvage in a majority of cases of infected breast reconstructions, thus avoiding total derailment of reconstruction or the need for autologous reconstruction. However, the protocols described involve multiple returns to the operating room, which translate to longer lengths of stay and increased costs to the hospital and the patient.…”

Section: Introductionmentioning

confidence: 98%

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Rinse But Don’t Repeat: Single Application V.A.C. VERAFLO Salvages Infected Breast Prostheses

Antognoli

Singh

Choudhry

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Introduction: Existing salvage protocols for infected breast prostheses using negative pressure wound therapy with instillation and dwell (NPWTi-d) require multiple returns to the operating room and prolonged length of stay. We present our expedited salvage protocol and discuss outcomes and associated costs savings. Methods: Using a retrospective review, we identified 25 consecutive patients (27 breasts) with peri-prosthetic breast infection. Nine patients (10 breasts) underwent removal of infected breast prostheses followed by autologous or staged implant-based reconstruction. Sixteen patients (17 breasts) underwent our single application salvage protocol. A cost analysis was performed comparing the two groups, and an economic model was used to project the cost savings associated with using single application NPWTi-d protocol. Results: Fifteen of the 16 patients (94%) who underwent single application NPWTi-d had successful implant salvage. Average duration of NPWTi-d was 2 days, 7 hours, and average length of stay was 4.43 days. Compared to control, patients who received the single application protocol required significantly fewer hospitalizations and office visits. A total savings of $58,275 could have been achieved by using the single application NPWTi-d protocol in the patients who did not undergo NPWTi-d. Conclusions: Single application of NPWTi-d is a simple, safe, and cost-effective technique for salvage of breast prostheses, with 94% success rate, even in immunocompromised patients and severe infection. Compared to previous protocols, ours requires fewer trips to the operating room, shorter length of stay, and more permanent implants placed during salvage. Our protocol is also associated with fewer office visits and fewer returns to the operating room.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: No Vac Changes In Single Application Npwti-dmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

See 3 more Smart Citations

Rinse But Don’t Repeat: Single Application V.A.C. VERAFLO Salvages Infected Breast Prostheses

Antognoli

Singh

Choudhry

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Is Instillational Topical Negative Pressure Wound Therapy in Peri-Prosthetic Infections of the Breast Effective? A Pilot Study

Grüner

Horch

Geierlehner

et al. 2022

JPM

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Peri-prosthetic breast infections pose a risk of severe complications after breast implant surgery. The need to remove the breast implant, control the infection and perform additional surgical procedures are the consequences. Reimplantation of an alloplastic implant is only appropriate after an infection-free interval. In this retrospective cohort study, we investigated the effectiveness of negative pressure wound treatment with instillation and dwell time (NPWTi-d) on peri-prosthetic breast infections in combination with implant removal and antibiotic therapy. Twelve patients treated with NPWTi-d due to breast implant infection were included in the study. The bacterial burden was analyzed using wound swabs before and after NPWTi-d. Additionally, laboratory values were determined before NPWTi-d and immediately before wound closure. A total of 13 peri-prosthetic breast infections in 12 patients were treated using implant removal and NPWTi-d. In 76.9% (n = 10) of the cases, the patients had undergone alloplastic breast reconstruction following cancer-related mastectomy, whereas 23.1% (n = 3) of the patients had undergone breast augmentation for cosmetic reasons. The bacterial burden in the breast pocket decreased statistically significant after implant removal and NPWTi-d. No shift from Gram-positive to Gram-negative bacteria was observed. Inflammatory markers rapidly decreased following treatment. NPWTi-d had a positive impact on the healing process after peri-prosthetic breast infections, leading to a decrease in bacterial burden within the wounds and contributing to uneventful healing. Therefore, secondary reimplantation of breast prostheses might be positively influenced when compared to conventional implant removal and simple secondary closure. Further studies are required to conclusively establish the beneficial long-term effects of using NPWTi-d for the treatment of peri-prosthetic breast infections.

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A Simple Technique Using Peri-Prosthetic Irrigation Improves Implant Salvage Rates in Immediate Implant-Based Breast Reconstruction

Gowda,

Jafferbhoy,

Marla

et al. 2023

Medicina

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Background and objectives: Implant-related complications leading to implant loss contribute to major morbidity in immediate breast reconstruction (IBR). Various techniques have been advocated to improve rates of reconstruction salvage. The objective of our study was to assess if a peri-prosthetic irrigation system was an effective adjunct to the conventional wash-out technique in improving reconstruction salvage rates. Methods: The study included patients who had immediate implant-based breast reconstruction from January 2015 to November 2020. The conventional technique of reconstruction salvage, using debridement, wash-out, and implant/expander exchange with systemic use of antibiotics, was performed for patients undergoing exploration for infection until May 2019. A simple technique using a continuous peri-prosthetic irrigation system with vancomycin (1 g/L normal saline over 24 h) for 2 days was added as an adjunct to the conventional technique. Treatment details and clinical outcomes were compared between the groups. The study was approved by the Clinical Governance department. Results: During the study period, 335 patients underwent IBR. A total of 65 patients (19.4%) returned to the theatre due to post-operative complications, of which 45 (13.4%) were due to infection. A conventional technique was used in 38 (84.4%) patients, and peri-prosthetic irrigation was used as an adjunct in 7 patients (15.6%). A total of 16 (42.1%) in the conventional group and all 7 (100%) in the irrigation group had successful reconstruction salvage. No patients had complications due to antibiotic irrigation. Conclusions: The peri-prosthetic irrigation system is a simple, safe, and effective adjunct to conventional techniques in improving reconstruction salvage in IBR.

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Salvaging the Unsalvageable: Negative Pressure Wound Therapy for Severe Infection of Prosthetic Breast Reconstruction

Cited by 4 publications

References 33 publications

Rinse But Don’t Repeat: Single Application V.A.C. VERAFLO Salvages Infected Breast Prostheses

Rinse But Don’t Repeat: Single Application V.A.C. VERAFLO Salvages Infected Breast Prostheses

Is Instillational Topical Negative Pressure Wound Therapy in Peri-Prosthetic Infections of the Breast Effective? A Pilot Study

A Simple Technique Using Peri-Prosthetic Irrigation Improves Implant Salvage Rates in Immediate Implant-Based Breast Reconstruction

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