scholarly journals Back to Basics: Could the Preoperative Skin Antiseptic Agent Help Prevent Biofilm-Related Capsular Contracture?

2018 ◽  
Vol 39 (8) ◽  
pp. 848-859 ◽  
Author(s):  
Jenny Carvajal ◽  
Melissa Carvajal ◽  
Gilma Hernández
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Bacterial Biofilm ◽  
Skin Microbiome ◽  
Level Of Evidence ◽  
Clinical Safety ◽  
Skin Preparation ◽  
Significant Difference ◽  
Chi Squared ◽  
Healthcare Epidemiology

AbstractBackgroundCapsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC.ObjectivesThe authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach.MethodsIn June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients.ResultsPearson’s chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed.ConclusionsCHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.Level of Evidence: 3

scholarly journals P144: Assessment of the quality of evidence presented at the Canadian Association of Emergency Physicians annual meeting over a five-year period (2013-2017)

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S108-S108
Author(s):  
V. Srivatsav ◽  
B. Zhang ◽  
I. Nadeem ◽  
S. Upadhye ◽  
Michael G. Degroote
Keyword(s):  
Emergency Medicine ◽  
Annual Meeting ◽  
Data Extraction ◽  
Level Of Evidence ◽  
Canadian Association ◽  
Predominant Type ◽  
Significant Difference ◽  
Chi Squared ◽  
Level I ◽  
Economic Analyses

Introduction: The CAEP annual meeting presents the latest evidence for clinical practice, but there has not yet been an appraisal of the abstracts presented at this conference. Therefore, we sought to evaluate the level of evidence of research presented at the annual meeting, and assess for trends over a five-year period (2013-2017). Methods: We conducted a scoping review that included all CAEP abstracts from 2013-2017, obtained through the Canadian Journal of Emergency Medicine. Two reviewers assessed eligibility and extracted data from abstracts individually, with conflicts resolved by a third reviewer. Qualitative research was excluded. Extracted data included type of presentation (ex. oral, poster), sample size, study design and type of study (therapeutic, prognostic, diagnostic, education, quality improvement, or systems-wide/economic analyses research). A level of evidence (LOE) was assigned using the 2011 Oxford Centre for Evidence-Based Medicine criteria. Results: Abstracts from 2014-2017 have been analyzed thus far, 1090 of which were eligible and 990 included. Inter-rater agreement for screening and data extraction was high ( value 0.87 and 0.84 respectively). Systems-wide/economic analyses research was the predominant type of study (28.6%, 283/990), followed by therapeutic (19.9%, 197/990) and education (19.9%, 195/990). The mean LOE was 2.81 (95% CI 2.77,2.85). The highest proportion of studies were of level III evidence (77.7%, 769/990), followed by level II (9.6%, 95/990) and level I evidence (7.8%, 77/990). 72.1% (124/172) of all level I and II abstracts were presented in 2016 and 2017. A significant change in LOE between years was evident (p<0.0001, chi-squared). The greatest proportion of level I and II abstracts were lightning oral (41.9%, 72/172), followed by posters (36.0%, 62/172). The best average LOE was observed for lightning oral (2.64, 95% CI 2.56, 2.72), with the poorest average LOE witnessed for moderated posters (2.90, 95% CI 2.83, 2.97). A significant difference was present in mean LOE between types of presentations (p<0.0001, one-sided ANOVA). Conclusion: The majority of abstracts were level III evidence. The lightning oral sessions had the greatest proportion of level I and II evidence presented. Recent years of the conference have also seen the presentation of a greater number of level I and II evidence, which may suggest a shift towards generating and disseminating higher level evidence in emergency medicine.

Prone versus modified supine percutaneous nephrolithotomy: which is more cost effective in an Australian tertiary teaching hospital?

2018 ◽  
Vol 12 (5) ◽  
pp. 391-395
Author(s):  
Isabel E-Hui Chu ◽  
Weranja Ranasinghe ◽  
Madeleine Nina Jones ◽  
Philip McCahy
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Treatment Options ◽  
Cost Effective ◽  
Renal Stones ◽  
Level Of Evidence ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Chi Squared ◽  
Recovery Times ◽  
Operative Costs

Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Materials and methods: A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a ‘bottom-up’, all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Results: There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) ( P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusions: Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of evidence: Not applicable for this multicentre audit.

scholarly journals Breast augmentation with silicone implants performed without drainage - retrospective analysis of 726 cases

2017 ◽  
Vol 74 (2) ◽  
pp. 152-155
Author(s):  
Nenad Stepic ◽  
Jovana Koncar ◽  
Milica Rajovic ◽  
Sanja Novakovic ◽  
Marijan Novakovic
Keyword(s):  
Retrospective Analysis ◽  
Breast Augmentation ◽  
Capsular Contracture ◽  
Surgical Techniques ◽  
Early Postoperative Period ◽  
Silicone Implants ◽  
Wound Drainage ◽  
Dual Plane ◽  
Significant Difference ◽  
Plane Technique

Introduction: Breast augmentation has been one of the most popular aesthetic procedures. Early complications, like infection, seroma, hematoma and capsular contracture like one of the most frequent long term complication, might be related to wound drainage. Aim of the study was to investigate the rate of the complications of breast augmentation procedure performed without drainage. Material and Methods. Retrospective analysis of all patients underwent breast augmentation in the period of 2003-2013 was performed. From the medical history of the patients, data related to demographic characteristics of the patients, surgical technique and rate of complications were collected. Wound drainage has not been used in any of the patients. Patients were followed at the discharge, after 7 days, three months and yearly thereafter. Wound seroma, wound hemathoma, wound infection and capsular contracture were followed. Results. There were 726 patients with average age of 28,5 year (22-48). Breast augmentation using silicone implants was performed with inframammary approach using subglandular, submuscular and dual plane technique. Average implant size was 339cc (200-520). Subglandular augmentation had 545 (75%), while, 181 (25%) received an implant in submuscular plane. Those, who were operated with dual plane technique were 86 (47,5%).In early postoperative period, there was no infection, five seromas (0,7 %) and eight hematoma (1,1%), while five of them required surgical evacuation. There was no statistical significant difference between the two surgical techniques in terms of complication rate. During follow up, there were three capsular contractures (0,4%). Conclusions. The incidence of complications in our group of patients after breast augmentation is low even though no drainage was used. Still, further randomized trials are needed to prove role of drainage in prevention of complications after breast augmentation.

scholarly journals The impact of breast augmentation on the skin temperature of the breast

2019 ◽  
Vol 76 (5) ◽  
pp. 518-523
Author(s):  
Branislav Piscevic ◽  
Zorica Brdareski ◽  
Nenad Stepic ◽  
Boban Djordjevic ◽  
Dejana Vulovic ◽  
...  
Keyword(s):  
Skin Temperature ◽  
Breast Augmentation ◽  
Cosmetic Surgery ◽  
Capsular Contracture ◽  
Late Complication ◽  
Adult Women ◽  
Breast Hypoplasia ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

Background/Aim. Complications of breast augmentation, as one of the most common cosmetic surgery, may be different. Besides usual early, local postoperative complicatons, the most common late complication is capsular contracture. As a specific complication of skin functions after this operation only disturbance of sensibility is described. Since the skin has other functions as well, and because there are no literature data available, the aim of this research was measuring the skin temperature before and after surgery. Methods. A prospective intervential study was done in 49 adult women. Bilateral augmentative mammaplasty was performed for breast hypoplasia or on the personal request of a patient with autrophic breasts. Measuring the temperature of the breast skin was done in two points, before the operation, and seven days and three months after surgery. The temperature measurement was done by the infrared thermometer (Pyrometer TROTEC BP21). Statistically significant difference was determined using the t-test for related samples. Differences were considered statistically significant if p was less than 0.05. Eta squared coefficient was use to determine the import size and according to the Cohen criteria everything over 10:14 signified a major impact. The data were analyzed by the IBP SPSS Statistics v20. Results. In a majority of patients the breasts were hypoplastic (69.39%). The most commonly used implants were 275?500 mL volume (46.94%), and the least common implants were over 500 mL (16.33%). In a little less than 2/3 of the patients submammary incision was used (61.22%). In a majority of patients (67.35%) the prosthesis were placed subglandularly. The average value of the temperature before the operation at the point 1 was 34.49?C, seven days after surgery 34.81?C, and three months after surgery 34.10?C; and at the point 2: 34.60 ?C, 34.91?C and 34.19?C in the same time intervals. In relation to the size of the breasts before operation and the size of the implant manufacturer, the localization of the incision and placement of the localization of the prosthesis, no statistically significant differences in the temperature of the skin of the breast before and after surgery was observed. Conclusion. Our results on the change of skin temperature after the breast augmentation could be significant preoperative information for the patients.

scholarly journals Does the Use of Intraoperative Breast Sizers Increase Complication Rates in Primary Breast Augmentation? A Retrospective Analysis of 416 Consecutive Cases in a Single Institution

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Lee Seng Khoo ◽  
Henrique N. Radwanski ◽  
Vasco Senna-Fernandes ◽  
Nsingi Nsosolo Antônio ◽  
Leonardo Luiz Fernandes Fellet ◽  
...  
Keyword(s):  
Complication Rate ◽  
Breast Augmentation ◽  
Capsular Contracture ◽  
Planning System ◽  
Silicone Implants ◽  
Complication Rates ◽  
Single Institution ◽  
Training Tool ◽  
Significant Difference ◽  
Novice Surgeon

Background. Is the use of intraoperative breast sizers beneficial for plastic surgeons or do they result in higher complication rates? Methods. This is a retrospective study of 416 consecutive cases of primary breast augmentation with silicone implants at the Plastic Surgery Service of Professor Ivo Pitanguy at the 38th Infirmary Santa Casa Misericórdia Hospital, Rio De Janeiro, from January 2011 to March 2014. 212 cases (51%) were carried out with use of intraoperative breast sizers with 204 cases (49%) without the use of implant sizers. This study compares the outcome of cases that employed the use of intraoperative implant sizers versus those that did not in terms of infection, hematoma/seroma formation, and capsular contracture. Results. Of 416 primary breast augmentation cases, there were 5 cases of infection (1.2%), 4 cases of seroma (1%), 3 cases of hematoma (0.7%), and 7 cases of capsular contracture (Baker’s Grade III/IV)(1.7%). Total complication rate limited to infection, seroma, hematoma, and capsular contracture was 1.15% (95% CI 0.96–1.93%). There was a significant difference in the scores for breast sizers (M = 4.3, SD = 1.4) and no breast sizers (M = 2.3, SD = 0.87) conditions, t(8) = 2.79, p=0.018. The use of implant sizers was correlated with a higher complication rate. Conclusion. Good results could be obtained without the use of breast sizers in primary breast augmentation with use of a biodimensional tissue based planning system while eliminating risks of infection and reducing intraoperative time. Notwithstanding, in a residency program breast sizers can be an excellent training tool to shorten the learning curve in the novice surgeon.

scholarly journals Subfascial Breast Augmentation: A Systematic Review and Meta-Analysis of Capsular Contracture

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Daniel J Gould ◽  
Orr Shauly ◽  
Levonti Ohanissian ◽  
W Grant Stevens
Keyword(s):  
Breast Augmentation ◽  
Meta Analysis ◽  
Capsular Contracture ◽  
Aesthetic Outcome ◽  
Level Of Evidence ◽  
Systematic Analysis ◽  
Final Study ◽  
The Aesthetic ◽  
Subfascial Breast Augmentation

Abstract Background Subfascial breast augmentation is a technique originally developed to reduce the risks of capsular contracture while decreasing the postoperative pain associated with subpectoral augmentation. It was pioneered in Brazil by Dr. Graf and others, and recently this technique has gained interest in the aesthetic world. Objectives The goal of this study was to provide a systematic analysis of subfascial breast augmentation to assess the combined reported rates of capsular contracture, animation deformity and complications. Methods The PubMed, Embase, and Web of Science databases were searched for the use of the subfascial plane for breast augmentation. We included studies that reported on capsular contracture and other outcomes following subfascial breast augmentation. Results Through the initial search, 26 articles were identified. Of which, 22 were included in the final study. A total of 3743 patients were identified across these studies with a total number of 38 cases of capsular contracture representing a rate of 1.01% of capsular contracture. Several articles reported on demographics, perioperative and long-term complications, and outcomes with regards to the aesthetic outcome from the surgeon’s perspective. Several infections were reported representing a rate of 0.1%. Animation deformity was not reported, although rippling was occasionally reported as was malrotation, axillary banding, sensory deficit, and asymmetry. Subfascial breast augmentation appears to have a low complication rate and an extremely low rate of capsular contracture at approximately 1%. Conclusions Subfascial breast augmentation may provide the benefits of low rates of capsular contracture while avoiding the discomfort and future animation deformity of subpectoral augmentation. Level of Evidence: 4

scholarly journals Antibiotic Irrigation of Pocket for Implant-Based Breast Augmentation to Prevent Capsular Contracture: A Systematic Review

2018 ◽  
Vol 26 (2) ◽  
pp. 110-119 ◽  
Author(s):  
Osama A. Samargandi ◽  
Nadim Joukhadar ◽  
Sarah Al Youha ◽  
Achilleas Thoma ◽  
Jason Williams
Keyword(s):  
Breast Augmentation ◽  
Controlled Trial ◽  
Capsular Contracture ◽  
In Vivo Studies ◽  
Controlled Study ◽  
Saline Irrigation ◽  
Randomized Controlled ◽  
Randomized Studies ◽  
Significant Difference

Background: In vitro and in vivo studies have described a number of different antibiotic solutions for irrigation of the pocket in implant-based breast augmentation in an attempt to prevent the formation of capsular contracture (CC). Our objective was to evaluate the evidence that antibiotic irrigation reduced the rate of CC. Methods: A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted from inception to January 2016. We included studies which examined the use of intraoperative antibiotic irrigation in women undergoing primary breast augmentation. Our primary outcome was the rate of CC. Included studies were assessed for methodological quality using validated tools. Results: Seven studies were included in the final analysis: 1 randomized controlled trial (RCT) and 6 non-randomized studies. The mean follow-up ranged from 14 to 72 months. The rate of CC was less than 2% in 8 studies, between 3% and 6% in 4 studies, and 13.9% in 1 study. Included studies demonstrated significant clinical and methodological heterogeneity. The solitary low-quality RCT concluded that antibiotic irrigation was superior to saline irrigation. Three non-randomized studies demonstrated no significant difference in the rate of CC with the use of antibiotics. One non-randomized controlled study showed that the use of mixture of antibiotic and povidone-iodine significantly lowered the rate of CC. Conclusions: The available evidence on the use of antibiotic irrigation to prevent CC is weak and it is based on studies with high risk of bias. Methodologically robust studies are necessary to answer the question whether antibiotic breast pocket irrigation prevents CC.

Reoperative Transaxillary Approach Algorithm: Extending the Surgical Alternatives for Secondary Breast Augmentation in the Era of Scarless Surgery

2020 ◽  
Vol 40 (11) ◽  
pp. 1179-1192 ◽  
Author(s):  
Alexandre Mendonça Munhoz
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Transaxillary Approach ◽  
Scarless Surgery ◽  
Aesthetic Result ◽  
Axillary Incision ◽  
Grade Ii

Abstract Background Although the transaxillary approach (TAA) is useful in primary breast augmentation (BA) surgery, drawbacks of this technique include the need to correct complications arising from reuse of the axillary incision. Objectives The purpose of this study was to assess the outcomes of secondary BA procedures performed via the TAA in a cohort of patients operated on by a single surgeon and to provide an algorithm for reoperative TAA technique selection. Methods Sixty-two patients (122 breasts) underwent secondary TAA BA, which was indicated for capsular contracture (CC) in 35 patients (56.4%). Periods for analysis included less than 10 days, 1, 3, 6, and 12 months, and then at 2-year intervals postprocedure. Results Forty-three patients (69.3%) had a previous premuscular (PM) pocket; in 35 (81.3%) of these patients the new pocket was kept in the same position. Nineteen patients (30.7%) had a previous submuscular pocket, and 15 patients (78.9%) had the new pocket transferred to the PM plane. Ten cases of complications were observed in 8 patients (16.1%), Baker grade II/III CC in 3 (4.8%), and axillary banding in 2 (3.2%), during a mean follow-up of 72 months (range, 6-170 months). Fifty-nine patients (95.1%) were either very satisfied or satisfied with their aesthetic result. Conclusions Recent progress in surgical techniques has led to significant improvements in aesthetic outcomes following BA. The TAA can play a useful role in secondary BA cases and our results show this procedure to be useful, with acceptable complication rates, and the added bonus of avoiding additional scarring on the breast. Level of Evidence: 4

scholarly journals Reoperation Rate After Primary Augmentation With Smooth, Textured, High Fill, Cohesive, Round Breast Implants (RANBI-I Study)

2018 ◽  
Vol 39 (12) ◽  
pp. 1342-1349 ◽  
Author(s):  
Julie Khanna ◽  
Mathew Mosher ◽  
Paul Whidden ◽  
Sébastien Nguyen ◽  
Diego Garzon ◽  
...  
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Breast Implants ◽  
Reoperation Rate ◽  
Level Of Evidence ◽  
Clinical Issue ◽  
Initial Surgery ◽  
Implant Size ◽  
Risk Rate

Abstract Background Reoperation after primary breast augmentation remains an important clinical issue. Objective The authors sought to evaluate incidence and causes of reoperation in patients who underwent primary augmentation. Methods This retrospective, noninterventional study conducted at 16 Canadian sites reviewed medical records and patient-completed questionnaires of women who underwent primary breast augmentation with smooth or textured Natrelle Inspira implants containing TruForm 1 or TruForm 2 gel. Patients were aged ≥22 years, received implants via inframammary fold incision, and returned for follow-up at 2 to 4 years. Results A total of 319 women received Inspira implants (smooth TruForm 2, n = 205; textured TruForm 2, n = 99; smooth or textured TruForm 1, n = 15). At follow-up, 30 women (9.4%) had undergone reoperation, including 19 (9.3%) in the smooth TruForm 2 subgroup and 9 (9.1%) in the textured TruForm 2 subgroup. The mean time to reoperation was 1.2 years; the risk rate for reoperation was 9.9% at 3 years. The most common reasons for reoperation were implant malposition (36.7%), capsular contracture (33.3%), and the patient’s request for a change in implant size or style (20.0%). Most women were very or somewhat satisfied with the initial surgery (89.3% overall; 90.7% smooth TruForm 2; 86.9% textured TruForm 2). Thirty-four women (10.7%) reported adverse events, including 20 (9.8%) in the smooth TruForm 2 subgroup and 14 (14.1%) in the textured TruForm 2 subgroup. Conclusions This analysis suggests that Natrelle Inspira TruForm 2 implants are safe when used in primary breast augmentation, resulting in low reoperation rates that are consistent with those for other breast implants. Level of Evidence: 4

Capsulectomy, Implant Exchange, and Placement of Acellular Dermal Matrix Is Effective in Treating Capsular Contracture in Breast Augmentation Patients

2019 ◽  
Author(s):  
Douglas S Wagner ◽  
Shayda J Mirhaidari
Keyword(s):  
Recurrence Rate ◽  
Complication Rate ◽  
Breast Augmentation ◽  
Capsular Contracture ◽  
Acellular Dermal Matrix ◽  
Implant Removal ◽  
Common Complication ◽  
Level Of Evidence ◽  
Dermal Matrix ◽  
Acellular Dermal

Abstract Background Capsular contracture is a common complication of breast augmentation surgery and many techniques to prevent and treat it have been suggested with inconsistent or variably effective results. Objectives The aim of this paper was to describe a protocol for treating established capsular contracture after breast augmentation with a low recurrence rate. Methods From January 2009 to December 2012, 79 previous bilateral breast augmentation patients presented for treatment of established capsular contracture. There were 135 breasts with capsular contracture: 56 were bilateral and 23 were unilateral. Ten patients opted for no treatment; 2 patients opted for implant removal. Twenty-four were treated with the ICES (implant exchange, capsulectomy, and possible exchange of site) protocol and 43 were treated with the SPICES (Strattice placement in the reconstructive position, implant exchange, capsulectomy, and possible exchange of site) protocol. Results The 24 patients treated with the ICES protocol had a recurrent capsular contracture rate of 15%. The 43 patients treated with the SPICES protocol had a 2.7% recurrent capsular contracture incidence and an 2.7% complication rate. Conclusions Capsular contracture after breast augmentation, whether primary or recurrent, can be successfully treated with the SPICES protocol. Level of Evidence: 4

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