Treatment of an Exposed Breast Implant by Muscle Flap and by Fascia Graft

Rempel, J

doi:10.1097/00000637-197803000-00014

Cited by 10 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 Investigating an alternative soft tissue cover, Rempel reported the use of a serratus anterior muscle flap to salvage a breast implant in the setting of recurrent exposure. 24 Using a technique similar to that of Toranto and Malow, 28 Weber and Hentz salvaged 100 percent of exposed breast implants using preoperative systemic antibiotic therapy and antibiotic lavage, followed by excisional débride-ment, open capsulotomy, wound irrigation, device exchange, and closed drain placement. 29 Building on Rempel's technique, Wilkinson reported a twoflap technique for soft-tissue coverage, consisting of a sling of serratus anterior and pectoralis muscle coupled with a Limberg skin flap.…”

Section: Discussionmentioning

confidence: 99%

“…31,32 For exposed breast prostheses, salvage techniques have included conservative wound care with systemic antibiotics, 19 device exchange with primary closure with or without posterior capsular flap coverage, 25,26 and device exchange combined with muscular coverage. 24 Despite a number of reports focusing on management of the infected or exposed breast prosthesis, there is still disagreement regarding the wisdom of and indications for device salvage and the optimal timing, setting, or technique. It would be valuable for plastic surgeons to better define a set of clinical guidelines addressing these very issues, given the medical, legal, psychological, and economic issues associated with possible implant loss.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Management of the Infected or Exposed Breast Prosthesis: A Single Surgeonʼs 15-Year Experience with 69 Patients

Spear

Seruya

2010

Plastic and Reconstructive Surgery

117

View full text Add to dashboard Cite

Salvage of the infected and/or exposed breast prosthesis remains a challenging yet viable option for a subset of patients. Relative contraindications include atypical pathogens on wound culture, such as gram-negative rods, methicillin-resistant S. aureus, and C. parapsilosis. Patients with a prior device infection and/or exposure and a history of either radiotherapy or S. aureus on wound culture should be monitored closely for signs of recurrence and managed cautiously in the setting of elective breast surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Management of the Infected or Exposed Breast Prosthesis: A Single Surgeonʼs 15-Year Experience with 69 Patients

Spear

Seruya

2010

Plastic and Reconstructive Surgery

117

View full text Add to dashboard Cite

show abstract

“…Rempel reported the use of a small serratus anterior muscle flap as a way to cover an exposed breast implant after aesthetic augmentation with no success [15]. Later he was cited by Wilkinson that described a two flap technique for implant coverage containing parts of the pectoralis major and serratus anterior muscles combined with a limberg skin flap [6].…”

Section: Discussionmentioning

confidence: 99%

Serratus anterior muscle flap as a salvage procedure in exposed implant-based breast reconstruction

Montag

Okada

Arruda

et al. 2019

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

HighlightsImplant based breast reconstruction is the most popular form of breast reconstruction following cancer treatment.Implant exposure normally leads to the loss of reconstruction due to contamination and infection.The two case series illustrate an approach to implant exposure with a novel use of the serratus anterior muscle flap. We discuss the main indications and technical aspects which can be helpful for surgeons dealing with similar cases.

show abstract

“…Courtiss et al 7 subsequently recommended that active intervention is necessary to save implants with periprosthetic infection 13 and that capsulotomy and dissection should be performed to avoid skin tension during treatment of threatened implant exposure. 15 Others have discussed salvage as an option, although some authors suggest that the management of such situations is a clinical judgment with few additional established guidelines. 2 In a rodent model, Marsh et al 13 studied the effect of timing on implant reinsertion in the face of infection.…”

Section: Discussionmentioning

confidence: 99%

“…2,9,10 Recommendations include device removal and capsulectomy only, 12 removal of the implant with retention of capsule, 9 explantation with delayed reinsertion, 10,11 implant retention with local pocket irrigation catheters, 19 -21 local revision with implant retention or immediate reaugmentation, 11 local muscle flaps, 15 and fascia lata grafts. 15 Admittedly, there has been, and continues to be, an evolution in the authors' treatment strategies for the clinical scenarios reported in this series. Because of the small number of patients in this study and the lack of a control group, the authors' treatment strategies do not benefit from statistical significance.…”

Section: Discussionmentioning

confidence: 99%

The Infected or Exposed Breast Implant: Management and Treatment Strategies

Spear

Howard

Boehmler

et al. 2004

Plastic and Reconstructive Surgery

165

114

View full text Add to dashboard Cite

Among the potential complications associated with the use of breast implants are the risks of periprosthetic infection and device extrusion. There is little published information about the effective management of these situations. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until the wound has healed. A retrospective review identified patients with periprosthetic infection or threatened or actual device exposure treated by the senior author. Twenty-four patients encompassing 26 affected prostheses were available for review and were classified into seven groups based on initial presentation as follows: group 1, mild infection (n = 8); group 2, severe infection (n = 4); group 3, threatened exposure without infection (n = 3); group 4, threatened exposure with mild infection (n = 3); group 5, threatened exposure with severe infection (n = 1); group 6, actual exposure without clinical infection (n = 5); and group 7, actual exposure with infection (n = 2). To salvage the prosthesis in these patients, various treatment strategies were utilized. All patients with a suspected infection or device exposure were started immediately on appropriate antibiotic therapy (oral antibiotics for mild infections and parenteral antibiotics for severe infections). Salvage methods included one or more of the following: antibiotic therapy, débridement, curettage, pulse lavage, capsulectomy, device exchange, primary closure, and/or flap coverage. Twenty (76.9 percent) of 26 threatened implants with infection or threatened or actual prosthesis exposure were salvaged after aggressive intervention. The presence of severe infection adversely affected the salvage rate in this series. A statistically significant difference exists among those patients without infection or with mild infection only (groups 1, 3, 4, and 6); successful salvage was achieved in 18 (94.7 percent) of 19 patients, whereas only two of seven of those implants with severe infection (groups 2, 5, and 7) were salvaged (p = 0.0017). Ten (90.9 percent) of 11 devices with threatened or actual exposure, not complicated by severe infection (groups 3, 4, and 6), were salvaged. Several treatment strategies were developed for periprosthetic infection and for threatened or actual implant exposure. Patients with infection were placed on oral or intravenous antibiotics; those who responded completely required no further treatment. For persistent mild infection or threatened or actual exposure, operative intervention was required, including some or all of the following steps: implant removal, pocket curettage, partial or total capsulectomy, débridement, site change, placement of a new implant, and/or flap coverage; the menu of options varied with the precise circumstances. No immediate salvage was attempted in five cases, due to either severe infection, nonresponding infection with gross purulence, marginal tissues, or lack of options for healthy tissue coverage. Based on the authors' experience, salvage attempts ...

show abstract

Treatment of an Exposed Breast Implant by Muscle Flap and by Fascia Graft

Cited by 10 publications

References 0 publications

Management of the Infected or Exposed Breast Prosthesis: A Single Surgeonʼs 15-Year Experience with 69 Patients

Management of the Infected or Exposed Breast Prosthesis: A Single Surgeonʼs 15-Year Experience with 69 Patients

Serratus anterior muscle flap as a salvage procedure in exposed implant-based breast reconstruction

The Infected or Exposed Breast Implant: Management and Treatment Strategies

Contact Info

Product

Resources

About