Closed-Incision and Surrounding Soft Tissue Negative Pressure Dressings in Post-Mastectomy Pre-Pectoral Direct-to-Implant Breast Reconstruction: A Pilot Study.

Background: Closed-incision and surrounding soft tissue negative pressure therapy (cistNPT) is theorized to decrease infection, reduce tissue edema, and promote healing of the mastectomy skin flap. We report our early experience with this dressing in pre-pectoral direct-to-implant (pDTI) breast reconstruction. Methods: We retrospectively reviewed all patients who underwent post-mastectomy pDTI breast reconstruction with cistNPT between July 2019 and February 2020. All reconstructions utilized smooth round silicone gel implants and human acellular dermal matrix. Results: Thirty-five female patients underwent 58 mastectomies. Mean age and body mass index were 49.9 years and 28.9 kg/m2, respectively. Eleven (31.4%) patients had neoadjuvant chemotherapy. The mean sternal notch-to-nipple distance was 27.0 cm. The median specimen weight was 483 g, while the median implant volume was 495 cc. The mean implant-to-specimen ratio was 1.4 for nipple-sparing, 1.1 for skin-sparing, and 0.7 for skin-reducing mastectomy. Total drain volume was 483.1 cc from each breast. Post-operative complications included seroma (5.2%), peri-incisional necrosis (8.6%), and superficial skin epidermolysis (13.8%). There were no cases of surgical site infection, dehiscence, or hematoma. Rate of return to the operative room was 3.4%. Mean follow-up was 90 days. Conclusions: In our series of pDTI breast reconstructions with cistNPT, no patients experienced hematoma, dehiscence, or infection complications. Rates of seroma, skin necrosis requiring operative debridement, and total drain volumes were lower than those reported in literature.

Contexte: La thérapie par pression négative des incisions fermées et des tissus mous environnants (cistNPT) doit théoriquement diminuer l'infection, réduire l'œdème tissulaire et faciliter la guérison du lambeau cutané de mastectomie. Nous fournissons notre première expérience avec ce pansement de reconstruction mammaire prépectorale directe à l'implant (pDTI). Méthodes: Nous avons revu rétrospectivement toutes les patientes ayant subi une reconstruction mammaire pDTI post mastectomie entre juillet 2019 et février 2020. Toutes les reconstructions ont utilisé des implants en gel de silicone lisses et ronds avec une matrice dermique acellulaire humaine. Résultats: Trente-cinq femmes ont subi 58 mastectomies. L'âge moyen était de 49,9 ans et l'IMC moyen de 28,9 kg/m2. Onze patientes (31,4 %) recevaient une chimiothérapie néoadjuvante. La distance moyenne du sommet du manubrium sternal au mamelon était de 27,0 cm. Le poids médian de l'échantillon était de 483 g tandis que le volume médian de l'implant était de 495 cc. Le rapport moyen implant/échantillon était de 1,4 pour la préservation du mamelon, 1,1 pour la préservation de la peau et de 0,7 pour la mastectomie de réduction cutanée. Le volume total de drainage de chaque sein a été de 483,1 cc. Les complications postopératoires ont été, notamment, un sérome (5,2 %), une nécrose péri-incision (8,6 %) et une épidermolyse superficielle de la peau (13,8 %). Il n'y a pas eu de cas d'infection du site chirurgical, de déhiscence ou d'hématome. Le taux de reprise chirurgicale a été de 3,4 %. Le suivi moyen a été de 90 jours. Conclusions: Dans notre série de reconstructions du sein par pDTI, aucune patiente n'a eu d'hématome, de déhiscence ou de complication infectieuse. Les taux de sérome, de nécrose cutanée nécessitant un débridement chirurgical et les volumes totaux de drainage étaient inférieurs aux chiffres publiés.

The influence of agility training on physiological and cognitive performance.

Agility training (AT) has recently been instituted in several military communities in hopes of improving combat performance and general fitness. The purpose of this study was to determine how substituting AT for traditional military physical training (PT) influences physical and cognitive performance. Forty-one subjects undergoing military technical training were divided randomly into 2 groups for 6 weeks of training. One group participated in standard military PT consisting of calisthenics and running. A second group duplicated the amount of exercise of the first group but used AT as their primary mode of training. Before and after training, subjects completed a physical and cognitive battery of tests including V[Combining Dot Above]O2max, reaction time, Illinois Agility Test, body composition, visual vigilance, dichotic listening, and working memory tests. There were significant improvements within the AT group in V[Combining Dot Above]O2max, Illinois Agility Test, visual vigilance, and continuous memory. There was a significant increase in time-to-exhaustion for the traditional group. We conclude that AT is as effective or more effective as PT in enhancing physical fitness. Further, it is potentially more effective than PT in enhancing specific measures of physical and cognitive performance, such as physical agility, memory, and vigilance. Consequently, we suggest that AT be incorporated into existing military PT programs as a way to improve war-fighter performance. Further, it seems likely that the benefits of AT observed here occur in various other populations.