"Reply - 313 Dermatome-Induced Lacerations: Incidence, Management, and Preventative Measures. April 2018, Volume 39, Issue Suppl 1, Page S126."

We would like to suggest the use of a simple and relevant mnemonic ("STSG") for the safe use of powered dermatomes to harvest split thickness skin grafts. Safety checklists have been shown to be effective tools for improving patient safety in various clinical settings by improving compliance with good practice and reducing the incidence of adverse events.

What Happened after the Poly Implant Prothèse Recall? A Prospective Cohort Study of 808 Implants into the Predictive Value of Implant Rupture on Postexchange Complications.

BACKGROUND: Problems with a variety of breast implants have emerged with consequences for patients' health and safety. The authors' goal was to follow up on their Poly Implant Prothèse patients after their implant exchange. METHODS: This single-center, single-surgeon, prospective cohort study lasted from 2012 until 2017. Implant size, implantation interval, surgical details, and complications were registered. The Clavien-Dindo classification was used to grade postoperative complications. Logistic regression was used to investigate whether rupture, interval between implantation and explantation, and new implant size were predictors of postexchange complications. RESULTS: The authors explanted 808 implants in 404 patients. The rupture rate was 30.9 percent per patient and 20.2 percent per implant. The capsular contracture rate at the time of exchange was low, with 1.86 percent of implants and 2.7 percent of patients; 97.8 percent of patients elected implant exchange and only 2.2 percent just wanted their implants removed. The mean follow-up after implant exchange was 5.2 years, with the last mandatory outpatient appointment usually being scheduled 6 to 12 months after implant exchange. The authors found that 74 patients (18.3 percent) and 124 implants (15.3 percent) had postexchange complications, the majority of them minor (83 percent Clavien-Dindo grade I). Patients with a ruptured implant at the time of exchange were significantly more likely to develop postexchange complications than were patients without rupture. CONCLUSIONS: This is the first study providing such a complete long-term postexchange follow-up of a single surgeon's Poly Implant Prothèse implant cohort. Implant rupture at the time of exchange had a high predictive value for postexchange complications in the authors' series of 808 implants and 404 Poly Implant Prothèse recall patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The no-drain, no-quilt abdominoplasty: a single-surgeon series of 271 patients.

BACKGROUND: Recent innovations in abdominoplasty include progressive tension "quilting" sutures or Scarpa fascia preservation to limit the risk of seromas and hematomas. No-drain abdominoplasty with progressive tension sutures has been well documented. The authors describe outcomes in patients undergoing abdominoplasty with a modified surgical technique (including sub-Scarpa fascia fat preservation) and no use of drains or progressive tension sutures-the "no-drain, no-quilt" abdominoplasty. METHODS: A retrospective, single-surgeon (A.A.Q.), single-site analysis of all abdominoplasty patients from 2003 to 2012 was performed. Data were extracted from paper case notes. All patients underwent surgery carried out under general anesthesia. The operative technique and postoperative regimen are described. RESULTS: Two hundred seventy-one patients were identified over the 10-year period. Patients had a mean age of 45 years and mean body mass index of 27, and 98 percent were women. Concomitant abdominal liposuction was undertaken in 61 percent of all patients (165 of 271). Twenty-one patients (7.7 percent) had a seroma and five patients (1.8 percent) had a hematoma. Seven patients (2.6 percent) required a return to the operating room to manage complications, and 24 (8.9 percent) required elective revision. Patients were admitted for an average of 1.7 days, and mean follow-up was 6.2 months. CONCLUSIONS: Abdominoplasty can be performed safely without drains or quilting sutures/progressive tension sutures. Benefits are discussed in terms of the potential for reduced intraoperative time (compared with progressive tension sutures), and reduced patient discomfort and inpatient stay (compared with drain use). The authors demonstrate low complication and elective revision rates in their series. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

PIP silicone breast implants: rupture rates based on the explantation of 676 implants in a single surgeon series.

INTRODUCTION: To determine the true rupture rates of PIP implants from a large single surgeon cohort and to assess whether rupture rates varied depending on time of implant insertion. In addition, the efficacy of ultra sound scanning (USS) in determining rupture is examined. DESIGN: Predominantly prospectively based analysis of patient records, investigations and surgical findings. PARTICIPANTS: 338 patients (676 implants) were included in the study and they all had removal of their implants. The senior author operated on all patients at some stage of their treatment. 160 patients were imaged pre-operatively with USS. Patients had implants inserted between 1999 and 2007 for cosmetic breast augmentation. RESULTS: A total of 144 ruptured implants were removed from 119 patients, giving a rupture rate of 35.2% per patient and 21.3% per implant over a mean implantation period of 7.8 years. A statistical difference (P < 0.001) in rupture rates between implants inserted prior to 2003 and those inserted from 2003 was demonstrated, with higher failure rates in the latter group. There was a significant difference in rupture rates depending on pocket placement of the implants. The sensitivity and specificity of USS at detecting rupture was 90.6% and 98.3% respectively. A proportion of patients (29.4%) demonstrated loco-regional spread of silicone to the axilla on scanning. CONCLUSIONS: Our paper has confirmed high rates of PIP implant failure in the largest published series to date. The significant difference in rupture rates between implants inserted prior to 2003 and those after this time supports the view that industrial silicone was used in the devices after 2003. Implants are more likely to rupture if inserted in the sub muscular plane compared to the sub glandular plane. USS is highly effective at detecting rupture in PIP implants and loco-regional spread is high compared to other devices. We believe this paper provides hard data enabling more informed decision making for patients, clinicians and providers in what remains an active issue affecting thousands of women.