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Background: Closed incision negative pressure therapy (ciNPT) may reduce the rate of wound complications and promote healing of the incisional site. We report our experience with this dressing in breast reconstruction patients with abdominal free flap donor sites. Methods: A retrospective cohort study was conducted of all patients who underwent breast reconstruction using abdominal free flaps (DIEP, MS-TRAM) at a single institution (Royal Melbourne Hospital, Victoria) between 2016 and 2021. Results: 126 female patients (mean age: 50 ± 10 years) were analysed, with 41 and 85 patients in the ciNPT (Prevena) and non-ciNPT (Comfeel) groups, respectively. There were reduced wound complications in almost all outcomes measured in the ciNPT group compared with the non-ciNPT group; however, none reached statistical significance. The ciNPT group demonstrated a lower prevalence of surgical site infections (9.8% vs. 11.8%), wound dehiscence (4.9% vs. 12.9%), wound necrosis (0% vs. 2.4%), and major complication requiring readmission (2.4% vs. 7.1%). Conclusion: The use of ciNPT for abdominal donor sites in breast reconstruction patients with risk factors for poor wound healing may reduce wound complications compared with standard adhesive dressings; however, large scale, randomised controlled trials are needed to confirm these observations. Investigation of the impact of ciNPT patients in comparison with conventional dressings, in cohorts with equivocal risk profiles, remains a focus for future research.

We report the first published case of Prototheca wickerhamii breast implant infection. This occurred after mastectomy, chemotherapy, radiotherapy, breast reconstruction, implant revisions and breast seroma aspirations and was preceded by polymicrobial infection. Definitive treatment required implant removal and intravenous liposomal amphotericin B. The management of breast prosthesis infections is discussed.

maintain the intrinsic plus position and collapse into the claw position.It should be noted that the secondary complications of a claw position, such as hyperlaxity of the MCP joints or flexion contractures of the PIP joints did not occur. A year after injury, when he had some motor (MRC grade 3) and sensory reinnervation, he was so used to the 'trick' movement to obtain the intrinsic plus position that training the intrinsic muscles was more difficult than expected.In summary, a patient with intrinsic paralysis was able to obtain and maintain an intrinsic plus position due to bowstringing at the MCP joint. This ability to maintain the intrinsic plus position should not to be mistaken for early reinnervation. LETTERS TO THE EDITOR Kanavel AB. Infections of the hand. A guide to the surgical treatment of acute and chronic suppurative processes in the fingers, hand and forearm, 7th edition. Philadelphia, Lea and Feibiger, 1939. Schnall SB, Vu-Rose T, Holtom PD et al. Tissue pressures in pyogenic flexor tenosynovitis of the finger. Compartment syndrome and its management.