“Just Pulse it!” Introduction of a conservative implant salvage protocol to manage infection in pre-pectoral breast reconstruction: Case series and literature review

Marcasciano, Marco; Kaciulyte, Juste; Giuli, Riccardo Di; Marcasciano, Fabio; Torto, Federico Lo; Guerra, Maristella; Prà, Giovanni Dal; Barellini, Leonardo; Mazzocchi, Marco; Casella, Donato; Ribuffo, Diego

doi:10.1016/j.bjps.2021.09.060

Cited by 7 publications

(5 citation statements)

References 38 publications

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“…We did not find significant differences in the analysis of the clinical outcomes between the two groups in the study or between these populations and the ones reported in the literature [ 19 , 41 , 42 , 43 ]. In two cases, a reintervention was required for implant exposure: one in the symmetrisation group and one in the immediate group.…”

Section: Discussioncontrasting

confidence: 46%

“…We had to remove the tissue expander in three cases because of implant exposure; one in the immediate symmetrisation group and two in the delayed group. In the case of the removal of the prepectoral tissue expander, in two cases a salvage surgery was performed with a submuscular replacement of the tissue expander with the selective denervation of the pectoralis major muscle [ 5 , 6 ] and in one case the tissue expander was removed and a surgical revision was made supplemented with an antibiotate pulse lavage of the pocket surface and a new definitive implant placement [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

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Controlateral Symmetrisation in SRM for Breast Cancer: Now or Then? Immediate versus Delayed Symmetrisation in a Two-Stage Breast Reconstruction

et al. 2022

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Introduction: The timing of contralateral symmetrisation in patients with large and ptotic breasts undergoing a unilateral skin-reducing mastectomy (SRM) is one of the most debated topics in the reconstructive field. There is no evidence to support the advantage of immediate or delayed symmetrisation to help surgeons with this decision. The aim of this study was to investigate the clinical and aesthetic outcomes of immediate symmetrisation. Methods: A randomised observational study was conducted on patients who underwent an SRM for unilateral breast cancer. Based on a simple randomisation list, patients were divided into two groups: a delayed symmetrisation group versus an immediate symmetrisation group. The postoperative complications, BREAST-Q outcomes and reoperations were compared. Results: Out of a total of 84 patients undergoing an SRM between January 2018 and January 2021, 42 patients underwent immediate symmetrisation and 42 patients had delayed symmetrisation. Three implant losses (7.2%) were observed and we reported three wound dehiscences; one of these was in a contralateral breast reconstruction in the immediate symmetrisation group. The BREAST-Q patient-reported outcome measures recorded better aesthetic outcomes and a high patient satisfaction for the immediate symmetrisation group. Conclusions: Simultaneous controlateral symmetrisation is a good alternative to achieve better satisfaction and quality of life for patients; from a surgical point of view, it does not excessively impact on the second time of reconstruction.

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Section: Discussioncontrasting

confidence: 46%

Section: Resultsmentioning

confidence: 99%

Controlateral Symmetrisation in SRM for Breast Cancer: Now or Then? Immediate versus Delayed Symmetrisation in a Two-Stage Breast Reconstruction

et al. 2022

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“…The rate of TE loss due to infection was 1.5% in the cluster using CS beads (p=0.02) and 11.9% in the cluster not using it, considering as an "infection" at least one of the following criteria: purulent drainage, spontaneous dehiscence of the surgical incision with positive bacterial swabs, evidence of abscess, or diagnosis by the surgeon of a deep infection occurring up to 1 year postoperatively. [32,33] The demonstrated efficacy in reducing the rate of implant removal is due to the ability of CS beads to attack biofilm, which is involved in resistant infections [34] and capsular contracture [35,36] and has recently been studied in relation to implant associated anaplastic large cell lymphoma [37]. In this regard, Howlin RP et al [38] published a study finding that high concentrations of an antibiotic released from calcium sulphate significantly reduced biofilm formation over several days.…”

Section: Discussionmentioning

confidence: 99%

State-of-the-Art Analysis of Antibiotic-Loaded Calcium Sulfate Beads in Plastic and Reconstructive Surgery: An Updated Systematic Review

Marcasciano,

Astolfi,

Fiorillo

et al. 2024

Preprint

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Calcium sulphate (CS) is currently used as a bioabsorbable, completely synthetic and sterile material in the management of infected tissues and dead spaces (DS) mainly resulting from surgical procedures. Residual DS in the postoperative, may create an environment where hematomas fill up and bacteria can proliferate, leading to a high incidence of postoperative infections. Considering the available reviews in the literature, CS has been mainly studied in orthopedic surgery mostly giving brilliant results and low complication rates. Nowadays, orthopedists avail it in the form of pearls both as a bone void filler and as an “off-label” delivery agent for antibiotics in arthroplasty, chronic osteomyelitis and open fractures, paving the way of its application in many other contexts given its natural dis-position to biodegradation. In the last years, CS beads have been gaining ground in the general, vascular and endocrinological surgical specialties. Despite its clear potential and the increasing number of scientific evidences on the safety and effectiveness of CS application in the prophylaxis and treatment of infections, there are not many studies reporting on its application in fields other than orthopedics, with a substantial paucity in plastic and reconstructive surgery literature. This is some-how surprising, since reconstructive surgery often deals with complex wounds secondary to bone and soft tissue exposure, suture dehiscence, trauma, and surgical site infections. As far as we know this is the first updated systematic review assessing the state of the art, indications and new perspectives on the application of CS beads in plastic and reconstructive surgery.

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“…Marcasciano et al used pulse therapy using Pulsavac (Pulsavac Plus, Zimmer Surgical Inc., Dover, OH, USA) to cleanse the surface of the breast pocket before replacing the implant [18]. Pulsavac produces intermittent, pulsed irrigation of the peri-prosthetic tissues that prevents the formation of biofilm and, hence, treats infection by reducing bacterial load.…”

Section: Discussionmentioning

confidence: 99%

“…Pulsavac produces intermittent, pulsed irrigation of the peri-prosthetic tissues that prevents the formation of biofilm and, hence, treats infection by reducing bacterial load. They tried this technique in eight patients and successfully salvaged all of them [18]. In all of these innovative techniques, success rates are high; however, it involves the use of complex kits and multiple antibiotics.…”

Section: Discussionmentioning

confidence: 99%

A Simple Technique Using Peri-Prosthetic Irrigation Improves Implant Salvage Rates in Immediate Implant-Based Breast Reconstruction

Gowda,

Jafferbhoy,

Marla

et al. 2023

Medicina

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Background and objectives: Implant-related complications leading to implant loss contribute to major morbidity in immediate breast reconstruction (IBR). Various techniques have been advocated to improve rates of reconstruction salvage. The objective of our study was to assess if a peri-prosthetic irrigation system was an effective adjunct to the conventional wash-out technique in improving reconstruction salvage rates. Methods: The study included patients who had immediate implant-based breast reconstruction from January 2015 to November 2020. The conventional technique of reconstruction salvage, using debridement, wash-out, and implant/expander exchange with systemic use of antibiotics, was performed for patients undergoing exploration for infection until May 2019. A simple technique using a continuous peri-prosthetic irrigation system with vancomycin (1 g/L normal saline over 24 h) for 2 days was added as an adjunct to the conventional technique. Treatment details and clinical outcomes were compared between the groups. The study was approved by the Clinical Governance department. Results: During the study period, 335 patients underwent IBR. A total of 65 patients (19.4%) returned to the theatre due to post-operative complications, of which 45 (13.4%) were due to infection. A conventional technique was used in 38 (84.4%) patients, and peri-prosthetic irrigation was used as an adjunct in 7 patients (15.6%). A total of 16 (42.1%) in the conventional group and all 7 (100%) in the irrigation group had successful reconstruction salvage. No patients had complications due to antibiotic irrigation. Conclusions: The peri-prosthetic irrigation system is a simple, safe, and effective adjunct to conventional techniques in improving reconstruction salvage in IBR.

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“Just Pulse it!” Introduction of a conservative implant salvage protocol to manage infection in pre-pectoral breast reconstruction: Case series and literature review

Cited by 7 publications

References 38 publications

Controlateral Symmetrisation in SRM for Breast Cancer: Now or Then? Immediate versus Delayed Symmetrisation in a Two-Stage Breast Reconstruction

Controlateral Symmetrisation in SRM for Breast Cancer: Now or Then? Immediate versus Delayed Symmetrisation in a Two-Stage Breast Reconstruction

State-of-the-Art Analysis of Antibiotic-Loaded Calcium Sulfate Beads in Plastic and Reconstructive Surgery: An Updated Systematic Review

A Simple Technique Using Peri-Prosthetic Irrigation Improves Implant Salvage Rates in Immediate Implant-Based Breast Reconstruction

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