Hypoglycaemic shock after partial skin graft harvesting.

Split skin harvesting is a common procedure in reconstructive surgery with only minor complications such as delayed wound healing. This is a case report of severe hypoglycaemia following harvesting of split skin from the anterior thigh of a type 1 diabetic patient, a 75-year-old male. The patient used to inject his long-acting insulin degludec subcutaneously in the anterior thigh. He was admitted with severe hypoglycaemia 18 hours post-operatively and required intravenous treatment the following 30 hours. Most likely, hypoglycaemia was caused by an excessive release of insulin degludec from subcutaneous depots.

Prophylactic treatment of breast implants with a solution of gentamicin, vancomycin and cefazolin antibiotics for women undergoing breast reconstructive surgery: protocol for a randomised, double-blind, placebo-controlled trial (The BREAST-AB trial).

INTRODUCTION: Periprosthetic infection is one of the most severe complications following implant-based breast reconstruction affecting 5%-10% of the women. Currently, many surgeons apply antibiotics locally on the breast implant to reduce the risk of postoperative infection, but no randomised, placebo-controlled trials have tested the treatment's efficacy. METHODS AND ANALYSIS: The BREAST-AB trial (BREAST-AntiBiotics) is an investigator-initiated, multicentre, randomised, placebo-controlled, double-blind trial of local treatment with gentamicin, vancomycin and cefazolin on breast implants in women undergoing implant-based breast reconstruction. The trial drug consists of 80 mg gentamicin, 1 g vancomycin and 1 g cefazolin dissolved in 500 mL of isotonic saline. The placebo solution consists of 500 mL isotonic saline. The trial drug is used to wash the dissected tissue pocket and the breast implant prior to insertion. The primary outcome is all-cause explantation of the breast implant within 180 days after the breast reconstruction surgery. This excludes cases where the implant is replaced with a new permanent implant, for example, for cosmetic reasons. Key long-term outcomes include capsular contracture and quality of life. The trial started on 26 January 2021 and is currently recruiting. ETHICS AND DISSEMINATION: The trial was approved by the Regional Ethics Committee of the Capital Region (H-20056592) on 1 January 2021 and the Danish Medicines Agency (2020070016) on 2 August 2020. The main paper will include the primary and secondary outcomes and will be submitted to an international peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT04731025.

Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial.

Background The incidence of breast animation deformity (BAD) is reported to be substantial after direct-to-implant breast reconstruction with subpectoral implant placement. It has, however, never been examined if BAD can occur following prepectoral implant placement. Our primary aim was to compare the incidence and degree of BAD after direct-to-implant breast reconstruction using either subpectoral or prepectoral implant placement. Secondary aim of this study was to assess and compare the level of pain between sub- and prepectoral reconstructed women. Methods In this randomized controlled trial, patients were allocated to reconstruction by either subpectoral or prepectoral implant placement in accordance with the CONSORT guidelines. The degree of BAD was assessed by the "Nipple, Surrounding skin, Entire breast (NSE)" grading scale 12 months after surgery. The level of postoperative pain was assessed on a numerical pain rating scale. Results We found a significant difference in the degree of BAD favoring patients in the prepectoral group (23.8 vs. 100%, p < 0.0001; mean NSE grading scale score: 0.4 vs. 3.6, p < 0.0001). The subpectoral reconstructed group reported higher levels of pain on the three subsequent days after surgery. No significant difference in pain levels could be found at 3 months postoperatively. Conclusion The incidence and degree of BAD was significantly lower in women reconstructed by prepectoral direct-to-implant breast reconstruction. Unexpectedly, we found mild degrees of BAD in the prepectoral group. When assessing BAD, distortion can be challenging to discern from rippling.

Visualized bilateral breast reconstruction by propeller thoracodorsal artery perforator flaps.

Thoracodorsal artery perforator (TAP) flaps are versatile flaps that provide a consistent and aesthetically pleasing breast reconstruction. We prefer the TAP flap to the latissimus dorsi (LD) flap due to the morbidity associated with the LD flap. In this paper we aim to show how we perform bilateral TAP flap breast reconstruction and present our preliminary results from 32 bilateral reconstructions in 16 patients. The TAP flap breast reconstruction can be performed as a direct-to-implant or a delayed procedure depending on patient factors. Color Doppler ultrasonography (CDU) is used in the preoperative planning which promotes the safety and reliability of the flap by mapping perforators thus enabling faster dissection. The bilateral TAP flap breast reconstruction is usually performed in three steps: (I) raising the flaps at the recipient site; (II) rotating the TAP flaps and (III) completion of the breast reconstruction.

Deep sternal wound infection after open heart surgery--reconstructive options.

OBJECTIVES: The management of sternal defects arisen after deep sternal wound infection is challenging and often requires extensive interdisciplinary teamwork between plastic and thoracic surgeons. In this study, the published literature on methods used to reconstruct sternal defects arisen as a result of deep sternal wound infection after open-heart surgery will be reviewed. DESIGN: The Cochrane, Embase, PubMed, and SveMed + databases were searched in December 2011. Only papers regarding treatment of deep sternal wound infection after open-heart surgery in adults were included. RESULTS: The literature search identified 224 original papers that met the inclusion criteria. The majority dealt with surgical techniques. None of the studies regarding reconstructive options were designed as randomized controlled trials, and the levels of evidence are generally low. CONCLUSION: The treatment of deep sternal wound infection has evolved considerably, but there is still little consensus regarding optimal surgical management and a general lack of a standard treatment protocol. The use of muscle flap transposition is well documented. Recent studies recommend the use of topical negative pressure therapy as an adjunct to surgical reconstruction.