Distant healing of surgical wounds: an exploratory study.

BACKGROUND: Distant healing intention (DHI) is one of the most common complementary and alternative medicine (CAM) healing modalities, but clinical trials to date have provided ambivalent support for its efficacy. One possible reason is that DHI effects may involve variables that are sensitive to unknown, uncontrolled, or uncontrollable factors. OBJECTIVE: To examine 2 of those potential variables-expectation and belief-we explored the effects of DHI on objective and psychosocial measures associated with surgical wounds in 72 women undergoing plastic surgery. DESIGN: Participants were randomly assigned to 1 of 3 groups: blinded and receiving DHI (DH), blinded and not receiving DHI (control), and knowing that they were receiving DHI (expectancy). Outcome measures included collagen deposition in a surrogate wound and several self-report measures. DHI was provided by experienced distant healers. No differences in the main measures were observed across the three groups. RESULTS: Participants' previous belief in the efficacy of DHI was negatively correlated with the status of their mental health at the end of the study (P = .04, 2-tailed), and healers' perceptions of the quality of their subjective "contact" with the participants were negatively correlated both with change in mood (P = .001) and with collagen deposition (P = .04). A post-hoc analysis found that among participants assigned to receive DHI under blinded conditions, those undergoing reconstructive surgery after breast cancer treatment reported significantly better change in mood than those who were undergoing purely elective cosmetic surgery (P = .004). CONCLUSION: If future DHI experiments confirm the post-hoc observations, then some of the ambiguity observed in earlier DHI studies may be attributable to interactions among participants' and healers' beliefs, their expectations, and their motivations.

New options for immediate reconstruction: achieving optimal results with adjustable implants in a single stage.

BACKGROUND: With the wide acceptance of immediate reconstruction and skin-sparing mastectomy and the precipitous decline in reimbursement for all types of breast reconstruction techniques, it is appropriate to revisit a technique that can achieve optimal reconstruction goals with a single general anesthetic operation. METHODS: A total of 322 consecutive cases in 14 years are reviewed. The mean patient age was 46 years (range, 20 to 76 years). Although this is not the first time a single-stage technique with adjustable implants has been reported, it is the largest series, and the technique was used in all consecutive patients during the past 14 years who were candidates for immediate implant reconstruction. The placement of a smooth-walled, permanently adjustable implant (Spectrum or Becker) entirely subcutaneously in the lower half of the breast, the use of shaping sutures initially, the careful placement of biopsy incisions, and aggressive initial debridement of mastectomy flaps are the keys to obtaining reliable results. Because of the partial or total subcutaneous placement of the implant, this method preserves the ptotic shape of the original breast without the need for subsequent expansion to obtain ptosis. RESULTS: Complications requiring major general anesthesia reoperations were capsular contracture [n = 61 (19 percent)], significant mastectomy flap necrosis ([n = 6 (1.9 percent)] seroma or hematoma [n = 16 (5 percent)], and periprosthetic infection [n = 7 (2.1 percent)]. Four infected implants were salvaged and three were removed and replaced at a later date. Most mastectomy flap necrosis was marginal and revised in the office under local anesthesia [n = 23 (7.1 percent)]. The rate of major necrosis requiring debridement in the operating room was 1.9 percent (n = 6). Aesthetic results were rated by patient and physician report to be excellent (78 percent), good (17 percent), or poor (5 percent). CONCLUSIONS: This technique achieves the goals of providing a ptotic reconstruction in one operation without the use of latissimus flaps or tissue expansion. The complication rate was low and the author discusses several methods for avoiding complications historically associated with immediate implant reconstruction.