Zafirlukast appears to effectively soften early capsular contracture and may prevent the formation of capsular contracture in those patients at risk. (Aesthetic Surg J 2002;22:329-336.).

The use of negative-pressure wound therapy (NPWT) has become the new standard of care for complex wounds. NPWT with instillation (NPWTi) has been shown to assist wound progression in a variety of wound types in an acute hospital setting with increased progression toward healing. We present the case of a 70-year-old male with Crohn's disease, who had post-operative life-threatening complications following hernia repair. His complex abdominal wound and a high-output fistula required the assistance of an entire clinical team.The multidisciplinary team's approach toward the patient was equivalent to the team's approach to the complex wound: "All Hands On Deck!" The cornerstone of our management was NPWT, specifically NPWTi. Instillation therapy was initiated. Complex foam application and innovative strategies to keep a grossly contaminated wound from becoming the final straw to a patient's demise appeared our greatest challenge.NPWTi was utilized and optimized, where every type of foam, bridge, and securement was needed to gain success. This patient's progress could be wholly attributed to the commitment and experience of a group of care providers who were led by their knowledge and experience in NPWT in the most challenging circumstances.

Abdominal wall reconstruction procedures have become increasingly popular in recent years as technology and surgical techniques have improved. The downside to these procedures has been the high rate of postoperative complications. Surgical site infections have been reported as high as 33.7% of the $9.8 billion spent annually on these complications. I present the case of a 62-year-old morbidly obese woman who underwent a combined procedure of abdominal wall reconstruction and panniculectomy. A total of 45 lbs of pannus was removed through a transverse incision that extended from hip to hip, measuring 90 cm in length. Following panniculectomy, abdominal wall reconstruction was performed by mobilizing the abdominal skin flap from the lower abdominal panniculectomy incision (avoiding a Tshaped incision with a traditionally high risk of dehiscence), and placement of biologic mesh as an underlay followed by fascial closure. Prevena Plus™ 125 (3M + KCI, San Antonio, TX) was applied for postoperative closed incisional negative pressure therapy (ciNPT) and continued for 10 days. No postoperative complications occurred. The incision healed without incident with no hernia recurrence at one year. ciNPT in high-risk patients can help minimize the risk of postoperative wound healing complications and should be considered in high-risk patients. Those patients undergoing combined procedures and especially morbidly obese patients undergoing combined abdominal wall reconstruction and panniculectomy are at particularly high risk for wound healing complications. ciNPT should be considered as a postoperative dressing of choice in this challenging patient population.

Introduction. Wound cleansing is integral during early-stage wound management and affords the transition to modalities promoting granulation tissue formation and reepithelialization, or preparation for wound coverage/closure. NPWTi-d includes periodic instillation of topical wound cleansing solutions and negative pressure for infectious material removal. Materials and Methods. This was a retrospective study of 5 patients who were admitted to an acute care hospital and treated for PI. After initial wound debridement, NPWTi-d instilled normal saline or HOCl solution (40 mL–80 mL) onto the wound for a dwell time of 20 minutes followed by 2 hours of subatmospheric pressure (−125 mm Hg). NPWTi-d duration was 3 to 6 days with 48-hour dressing changes. Results. NPWTi-d helped cleanse 10 PIs in 5 patients (age, 39–89 years) with comorbidities to facilitate primary closure using rotation flaps. In 4 patients, rotation flap closures were performed without immediate postoperative complications, followed by hospital discharge within 72 hours. In one patient, closure was preempted due to an unrelated medical issue. A stoma was created to prevent further contamination. The patient returned for flap coverage post colostomy. Conclusion. The findings herein support the use of NPWTi-d in the cleansing of complex wounds and suggest that it may facilitate an expedited transition to rotation flap closure for this wound type.