The importance of the malleable implant salvage technique (MIST) in modern prosthetic urology

Objectives Odontogenic chronic rhinosinusitis (CRS) is an epidemiologically important disease process due, in part, to the increasingly commonplace use of dental restorative procedures such as zygomatic implantation. Traditional management of this clinical entity typically entails extraction of the infected hardware via an open or endoscopic approach. We describe a novel management strategy of odontogenic CRS following bilateral zygomatic implantation for oral rehabilitation that we surgically salvaged via a modified endoscopic medial maxillectomy. Methods We describe the presentation and management of a case of metachronous development of bilateral CRS subsequent to zygomatic implantation. Results The patient's postoperative course was characterized by marked endoscopic, radiologic, and symptomatic improvement as measured by the 22-item Sino-Nasal Outcome Test. Conclusion We describe a novel treatment strategy for the management of odontogenic sinusitis resulting from erroneous zygomatic implant placement. Modified endoscopic medial maxillectomy in this clinical context facilitates mucosal normalization of the affected sinus, while permitting preservation of oral function through salvage of the displaced implant.

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P111: Breast implant salvage after postoperative infection - Successful new technique

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2020.03.150 ◽

2020 ◽

Vol 46 (6) ◽

pp. e39

Author(s):

Anitha Muthusami ◽

Matthew Green ◽

Phil Brookes ◽

Iqbal Kasana

Keyword(s):

Postoperative Infection ◽

Breast Implant ◽

New Technique ◽

Implant Salvage

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A breast prosthesis infection update: Two-year incidence, risk factors and management at single institution

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_215_17 ◽

2018 ◽

Vol 51 (01) ◽

pp. 007-014 ◽

Cited By ~ 4

Author(s):

Ashley Nadia Boustany ◽

Shady Elmaraghi ◽

Nneamaka Agochukwu ◽

Benjamin Cloyd ◽

Adam J. Dugan ◽

...

Keyword(s):

Risk Factors ◽

Breast Reconstruction ◽

Smoking Status ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Antibiotic Use ◽

Modifiable Risk Factors ◽

Skin Preparation ◽

Surgical Interventions ◽

Implant Salvage

ABSTRACT Background: Infection following augmentation and prosthetic-based breast reconstruction can cause significant physical and psychological distress for patients. It may delay adjuvant therapies and compromise aesthetic outcomes. The aim of this study is to identify modifiable risk factors for infection and identify common bacterial isolates to achieve optimal outcomes for patients. Methods: A retrospective cohort study was performed for patients undergoing implant-based breast reconstruction over a 2-year period. In each case, we documented demographics, co-morbidities, complications and antibiotic use. We reviewed treatments, infectious species cultured where applicable and all outcomes. Results: A total of 292 patients met the inclusion criteria. Fifty-five patients (19%) developed an infection. Univariate analysis showed a significantly increased infection rate with longer operative times (P = 0.001) and use of tissue expanders (P = 0.001). Multiple logistic regression analysis confirmed drain use and elevated body mass index (BMI) as risk factors (odds ratio [OR] 2.427 and 1.061, respectively). After controlling for BMI, smoking status and radiation, we found an increased odd of infection with allograft use (OR 1.838) and a decreased odd with skin preparation using 2% chlorhexidine gluconate in 70% isopropyl (OR 0.554), though not statistically significant. Forty of 55 patients with infections had cultures, with 62.5% of isolates being Gram-positive species and 30% Gram-negative species. The median time to clinical infection was 25 days. Implant salvage with surgical interventions was achieved in 61.5% of patients. Conclusions: This study identified judicious use of drains and efficiency in the operating room as modifiable risk factors for infections following implant-based breast reconstruction. Prospective trials to analyse techniques for infection prevention are warranted. Implant salvage following infection is a possible end-point in the appropriate patient.

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