The Levine swab is superior to the Z-swab technique and may be useful for initial wound monitoring, but quantitative biopsies are preferred for evaluation of antibiotic-resistant wounds and to monitor the response to treatment. There is limited evidence on the role of wound swabs for detecting wound colonisation versus infection and the impact of culture-guided therapy on such clinical outcomes as eradication of infection and accelerated healing. Future studies should specify patient populations, wound types, sampling protocols, and outcomes based on culture yield and treatment results, using rigorous statistical methodology.

Background:Nipple-sparing techniques have improved the aesthetics of reconstruction following mastectomy, but nipple necrosis complicates up to 37% of procedures, distressing patients, delaying adjuvant therapy, and compromising outcomes. No method reliably detects nipple necrosis better than clinical assessment of tissue perfusion. We prospectively assessed the accuracy of intraoperative indocyanine green laser angiography to predict nipple necrosis.Methods:Twenty consecutive women undergoing immediate tissue expander breast reconstruction following 32 nipple-sparing mastectomies underwent indocyanine green fluorescence imaging to assess nipple perfusion immediately before and after intraoperative tissue expansion. Imaging findings were correlated with postoperative nipple viability.Results:Among the 32 nipple-sparing mastectomies (8 unilateral, 12 bilateral) in 20 women (mean age, 48 years), partial or full-thickness necrotic changes developed in 3 breasts of 2 patients (10%). Imaging identified impaired perfusion and predicted necrosis in these cases.Conclusions:In this initial series, intraoperative indocyanine green laser angiography correctly identified patients who developed nipple necrosis during mastectomy and tissue expander breast reconstruction.

CASS reduced operating room time, likely due to improved efficiency and accuracy. Our data demonstrate that hospitals with similar cost structure as ours, performing greater than 27 cases of 3D head and neck reconstructions per year can see a financial benefit from developing an in-house CASS program.