Negative Pressure Wound Therapy in Postbariatric Lower Body Lift-A Method of Decreasing Postoperative Complications.

BACKGROUND: Lower body lift procedure is one of the most common procedures in postbariatric surgery, which can be followed by postoperative complications that delay the healing time. The purpose of this study was to analyse whether the use of negative pressure wound therapy (NPWT) as a replacement for the classical drainage method would provide better postoperative results with fewer complications. METHODS: The authors reviewed their experience with 46 consecutive patients that underwent lower body lift surgery from 2018 to 2021. They were divided into two groups: 23 of them received NPWT as drainage method and another 23 received classical active drains. We assessed the complication rates and types between the two groups to demonstrate the efficiency of NPWT as a support in the surgical protocol. RESULTS: Forty-six patients were included in this study. Two equal groups formed by 23 patients were analysed for age, sex, type of weight loss, type of circumferential lower body lift, type of drainage, quantity of drainage, time of drain usance, postoperative complications, operation time, hospital stay and frequency of hospital visits. The group that received NPWT had a 26.08% rate of complications as compared with the drain group that had a 47.8% complication rate. CONCLUSIONS: This study is performed as a comparison between negative pressure wound therapy and classical drainage method in lower body lift surgery, as a new method of reducing the postoperative complications. By achieving faster closure of large, undermining areas, it concludes in a lower risk of seroma or hematoma formation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Microbiologic Safety of the Transareolar Approach in Breast Augmentation.

BACKGROUND: In aesthetic breast augmentation, especially by the transareolar approach, there is increasing concern regarding the occurrence of capsular contracture and its potential correlation with intraoperative implant contamination from putative endogenous breast flora of the nipple and lactiferous ducts. However, detectable bacteria cannot be considered synonymous with established resident microflora. OBJECTIVES: The authors sought to elucidate the existence of endogenous breast flora and assess the microbiologic safety of transareolar breast augmentation. METHODS: In this prospective study (BREAST-MF), the authors collected microbiologic samples from the breast skin, ductal tissue, and parenchyma of 39 consecutive female patients who underwent breast procedures in a plastic surgery clinic. Swabs collected pre-, intra-, and postoperatively were processed for bacterial and fungal growth. Positive cultures underwent identification through VITEK and MALDI-TOF, as well as antimicrobial susceptibility testing. RESULTS: Staphylococcus species accounted for 95 of 106 (89.6%) positive results from native breast skin, 15 of 18 (83.3%) positive results from decontaminated breast skin, and 4 of 4 (100%) positive results from the breast parenchyma. Methicillin resistance was present in 26.4% of S. epidermidis, 25.3% of S. hominis, and 71.4% of S. haemolyticus strains. CONCLUSIONS: During transareolar breast augmentation, in the nipple-areola region it is more likely to find bacteria populating the skin, rather than endogenous breast flora, as previously considered. Appropriate preoperative decontamination is essential for minimizing the risk of postoperative infections. LEVEL OF EVIDENCE 3: Risk.

The synergy between lasers and adipose tissues surgery in cervicofacial rejuvenation: histopathological aspects.

BACKGROUND AND AIMS: Nowadays patients want a long-lasting youthful appearance but through a less invasive approach. Our unique approach, "AdipoLASER reJuvenation (ALJ)", involves a variety of less invasive techniques based on simultaneous laser resurfacing, and lipolysis together with adipose tissue graft and redistribution. Recently, we added to this platelet-rich plasma therapy. We conducted a study aiming to emphasize the histopathological changes occurred following these procedures. PATIENTS AND METHODS: Between 2011-2012, we included 50 patients that were preparing for abdominoplasty (tummy tuck) in which we applied ALJ procedures, in two comparative zones of inferior abdomen. Histological examination varied from 10 days to four months, according to the time of the abdominoplasty. RESULTS: There was a notable histological difference between stimulated and non-stimulated fat graft regarding adipose cells structure and number, neocollagenesis, and dermal matrix remodeling. CONCLUSIONS: The low level laser therapy effect (LLLT) of the fractional CO2 laser combined with the effect of the growth factors derived from activated platelets (PRP) prolonged the life and improved the take of the facial fat graft, increase collagen formation and lead to a better remodeling of the dermal matrix. This unique surgical combination of all four approaches in our ALJ with additional PRP offers a real less invasive but strongly visible - yet natural result - as an alternative to the classic facelift.

BReast Ecology Assessment in the STudy of local MicroFlora - Study Protocol.

INTRODUCTION: Recent articles have described an endogenous breast flora, particularly in the nipple ducts, with potential implications in the outcome of aesthetic breast surgery. To characterize the ecology of the breast, we designed a study to assess the microbial species identified on the breast skin and parenchyma in patients undergoing breast surgical interventions. METHODS: AFTER OBTAINING INFORMED CONSENT AND BACKGROUND DATA ON CONCURRENT DISEASES, PREVIOUS CONTACT WITH THE HOSPITAL SYSTEM AND PRIOR USE OF ANTIBIOTICS, SAMPLES ARE COLLECTED PREOPERATIVELY FROM THREE AREAS OF THE BREAST SKIN, BILATERALLY: the inframammary fold, the areola and the axilla, prior to decontamination. These samples will serve as positive controls and will aid in characterizing the normal breast skin flora. After preoperative decontamination, samples are again collected, to check for any residual bacterial flora and the nipple is sealed with Tegaderm (3M, USA) and betadine ointment, to reduce any putative bacterial load. Intraoperatively, samples are collected from: a) the incision line (dermal level): 1. superficially, 2. medium depth in the breast parenchyma, 3. deep parenchyma, and b) axillary parenchyma (where possible), together with a bioptic fragment. Postoperatively, a second nipple sample is collected. For secondary breast augmentation surgeries, capsular biopsy is also performed (where relevant), and the implants undergo sonication, to allow biofilm identification. In the laboratory, all samples are cultured on blood agar incubated with CO2, cystine lactose electrolyte deficient medium and Sabouraud gentamicin-chloramphenicol agar. For positive culture samples, the number of colonies and their morphologic characteristics are reported. Identification will be carried out with MALDI-TOF and VITEK (bioMérieux, France), yielding automated antibiotic sensitivity profiles. For all germs with sensitivity profiles differing from the wild-type strain, E-tests will be performed. Follow-up information on the postoperative evolution will be collected and analyzed for potential factors predictive of good evolution. DISCUSSION: This study will provide important information about the microflora of the breast skin, its sensitivity profile, and the degree of contamination of the nipple ducts and parenchyma, if any, addressing a scientific hypothesis insufficiently explored so far.