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Brown A. The use of PICO ™ single-use negative pressure wound therapy in the community settings. Br J Community Nurs 2024; 29:S8-S26. [PMID: 39240814 DOI: 10.12968/bjcn.2024.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
The prevalence and incidence of wounds is predicted to rise due to an ageing population, that is also likely to have an increasing number of comorbidities (Dowsett et al, 2017). This trend will invariably result in increased costs to the NHS. The estimated annual cost of wound management in 2017/2018 was £8.3 billion. The cost of managing 70% of wounds which healed was £2.7 billion while it cost £5.6 billion managing only 30% of unhealed wounds (Guest et al, 2020). In view of these figures, it is important that health professionals (HPs) recognise wounds that are not progressing to healing at an early stage and implement all available treatment modalities to ensure that the wound does not become non-healing or stalled. Therefore, this article defines non-healing wounds, how to identify wounds at risk of becoming non-healing and the timely implementation of advanced treatment modalities, such as single use negative pressure wound therapy (sNPWT).
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Singh DP, Gabriel A, Silverman R, Bongards C, Griffin L. Meta-Analysis Comparing Outcomes of Two Different Closed Incision Negative Pressure Systems in Breast Surgery and Implications to Cost of Care. EPLASTY 2024; 24:e40. [PMID: 39224414 PMCID: PMC11367156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background Surgical site complication (SSC) rates in breast surgery have been reported between 2.25% and 53%. Use of incision management may help reduce the risk of SSCs. The potential of 2 closed incision negative pressure therapy (ciNPT) systems to mitigate surgical site complications (SSC) and surgical site infections (SSI) in breast surgery were assessed. Methods A systematic literature review for breast surgery studies was conducted comparing ciNPT use against standard of care (SOC). SSC, SSI, and dehiscence rates were examined. SSCs were defined as all surgical site complications including SSI, dehiscence, seroma, hematoma, and necrosis. Risk ratios and random effects models were used to assess the effect of ciNPT with multilayer absorbent dressing (ciNPT-MLA) and ciNPT with foam dressing (ciNPT-F) compared with SOC. Results Eight articles were included in the meta-analysis. No significant differences in SSC rates (P = .307) or SSI rates (P = .453) between ciNPT-MLA and SOC were observed. ciNPT-MLA use was associated with a reduction in dehiscence compared with SOC (RR = 0.499, 95% CI = 0.303, 0.822; P = .006). A significant reduction in SSC rates (RR = 0.498, 95% CI = 0.271, 0.917; P = .025) was observed with ciNPT-F use. Similarly, dehiscence rate reduction was associated with ciNPT-F use (RR = 0.349, 95% CI= 0.168, 0.725; P = .005). A trend towards reduction of SSI rates with ciNPT-F use compared with SOC was also noted (P = .053). Conclusions Compared with SOC, ciNPT-MLA significantly reduced rates of dehiscence, while ciNPT-F use resulted in significantly reduced SSC and dehiscence rates with a trend toward reducing SSI.
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Affiliation(s)
- Devinder P. Singh
- Plastic Surgery, University of Miami Health System and Miller School of Medicine, Miami, Florida
| | - Allen Gabriel
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California
- Private Practice, AG Plastic Surgery, Vancouver, Washington
| | - Ronald Silverman
- Plastic Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Leah Griffin
- Global Health Economics, Solventum, Maplewood, Minnesota
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Vidya R, Khosla M, Baek K, Vinayagam R, Thekkinkattil D, Laws S, Douvetzemis S, Sircar T, Mullapudi A, Murphy J. Prophylactic Use of Negative Pressure Wound Therapy in High-risk Patients Undergoing Oncoplastic and Reconstructive Breast Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5488. [PMID: 38115832 PMCID: PMC10730037 DOI: 10.1097/gox.0000000000005488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/24/2023] [Indexed: 12/21/2023]
Abstract
Background Negative pressure wound therapy (NPWT) has emerged as an adjunct to reduce wound complication rates in many surgical domains. This study investigated the prophylactic use of PICO NPWT in high-risk patients undergoing oncoplastic and reconstructive breast surgery. Methods This was a prospective multicenter national audit. The findings were compared against Association of Breast Surgery/British Association of Plastic, Reconstructive and Aesthetic Surgeons (ABS/BAPRAS) Oncoplastic Guidelines for best practice. Results Data from 267 patients were included from seven centers. All patients had at least one high-risk factor for postoperative wound complications, whereas 78 patients (29.2%) had more than one. Thirty-six patients (13.5%) developed postoperative wound complications. An estimated 16 (6%) developed skin flap necrosis, wound dehiscence occurred in 13 patients (4.9%), and 15 patients (5.6%) developed postoperative wound infection. Eleven patients (4.1%) required further surgery due to wound complications. In total, 158 patients underwent mastectomy with immediate implant reconstruction. Postoperative wound complication rate was comparable in this subgroup (n = 22; 13.9%). Implant loss rate was 3.8%, which was within the 5% target mentioned in the ABS/BAPRAS guidelines. The estimated total cost saving was US $105,600 (£84,613) and US $395.50 (£316.90) per patient. Wound infection rate (5.6%) was much lower than the 25% reported by both iBRA study and National Mastectomy and Breast Reconstruction Audit. Conclusions Our study suggests that prophylactic use of NPWT in oncoplastic and reconstructive breast surgery results in low rates of wound-related complications with associated healthcare cost benefits in patients with high-risk factors for wound-related complications. However, a prospective randomized control trial is required.
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Affiliation(s)
- Raghavan Vidya
- From The Royal Wolverhampton NHS Trust, Wolverhampton, U.K
| | - Muskaan Khosla
- From The Royal Wolverhampton NHS Trust, Wolverhampton, U.K
| | - Kim Baek
- St. James’s University Hospital, Leeds, U.K
| | - R. Vinayagam
- Wirral Breast Centre, Clatterbridge Hospital, Wirral, U.K
| | | | | | | | - Tapan Sircar
- From The Royal Wolverhampton NHS Trust, Wolverhampton, U.K
| | | | - John Murphy
- Nightingale Breast Centre, Manchester University NHS Foundation Trust, Manchester
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Ozturk CN, Ozturk C, Magner WJ, Ali A, Diehl J, Sigurdson SL. Seroma After Breast Reconstruction With Tissue Expanders: Outcomes and Management. Ann Plast Surg 2023; 91:331-336. [PMID: 37347178 DOI: 10.1097/sap.0000000000003573] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Seroma is a relatively common complication after breast reconstruction with tissue expanders. The main risk in the presence of seroma is development of periprosthetic infection, which can lead to implant loss. Our goals were to identify risk factors for seroma, and to describe our protocol for managing fluid accumulation. PATIENTS AND METHODS An IRB approved breast reconstruction database was reviewed to identify patients who underwent tissue expander reconstruction. Patient characteristics, details of surgery, outcomes and treatment were recorded. RESULTS Two hundred nineteen tissue expander reconstructions were performed in 138 patients. Twenty-eight reconstructions developed seroma (12.8%), and 75 were identified to have prolonged drains (34.2%). Seroma was more common in patients with lymph node surgery ( P = 0.043), delayed reconstruction ( P = 0.049), and prepectoral reconstruction ( P = 0.002). Seroma and/or prolonged drains were more commonly noted in patients with higher body mass index ( P = 0.044) and larger breast size ( P = 0.001). Aspiration was the most common intervention (85.7%), which was performed in the clinic utilizing the expander port site. There was no difference in infection or explantation rate between seroma and no-seroma patients ( P = 0.546 and 0.167), whereas patients with any fluid concern (seroma and/or prolonged drains) were more prone to developing infection and undergoing explantation ( P = 0.041 and P < 0.005). CONCLUSION We recommend that prolonged drain placement longer than 3 weeks should be avoided, and patients should be screened for fluid accumulation after drain removal. Serial aspiration via expander port site and continuation of expansion provide a safe and effective method to manage seromas to avoid infection and expander loss.
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Affiliation(s)
- Cemile Nurdan Ozturk
- From the Department of Head, Neck & Plastic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Total autologous breast reconstruction with the Kiss Latissimus Dorsi Flap. J Plast Reconstr Aesthet Surg 2022; 75:3673-3682. [DOI: 10.1016/j.bjps.2022.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 04/12/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022]
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Chicco M, Huang TCT, Cheng HT. Negative-Pressure Wound Therapy in the Prevention and Management of Complications From Prosthetic Breast Reconstruction: A Systematic Review and Meta-analysis. Ann Plast Surg 2021; 87:478-483. [PMID: 34060773 DOI: 10.1097/sap.0000000000002722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Complications from prosthetic breast reconstruction are distressing for patients, and their management is challenging. For decades, negative-pressure wound therapy (NPWT) has been successfully used for the closure of complex wounds. This study analyzes the outcomes of NPWT use in the prevention and management of complications from prosthetic breast reconstruction. METHOD A systematic search of studies published until August 2020 was conducted using the PubMed/MEDLINE, EMBASE, and Ebscohost/CINAHL databases and using the following key words: "negative-pressure wound therapy," "breast reconstruction," and "prosthesis" (including breast implants and tissue expanders). Analyzed endpoints were outcomes of NPWT use in prosthetic breast reconstruction compared with conventional dressings. The methodological quality of included studies was assessed independently. Comparative studies were further meta-analyzed to obtain pooled odds ratios (ORs) describing the effectiveness of NPWT in prosthetic breast reconstruction. RESULTS/DISCUSSION Ten studies were included with a total of 787 patients (1230 breasts) undergoing prosthetic breast reconstruction with breast implants or tissue expanders. Three case-control studies focused on preventing breast wound complications. The meta-analysis of the 3 studies included 502 breasts receiving NPWT and 698 breasts receiving conventional wound care. The meta-analysis favored NPWT for less mastectomy flap necrosis (5.6% vs 14.3%; OR, 0.46; 95% confidence interval, 0.27 -0.77; P = 0.004; I2 = 0%) and less overall wound complications (10.6% vs 21.1%; OR, 0.49; 95% confidence interval, 0.35-0.70; P < 0.00001; I2 = 0%). In the management of nipple-areolar complex venous congestion, 1 case report demonstrated 85% rescue of nipple-areolar complex after using NPWT (-75 mm Hg) for a total of 12 days. In the management of periprosthetic infections, 2 case series used NPWT with instillation. It accelerated the treatment of infection and maintained the breast cavity for future reconstruction. Conventional NPWT also showed good salvage outcome in four studies. CONCLUSIONS Current evidence suggests that prophylactic use of NPWT in prosthetic breast reconstruction reduces the rate of overall wound complications and mastectomy flap necrosis. In the management of complications from prosthetic breast reconstructions, NPWT may be a promising option showing beneficial results. Additional high-quality trials are warranted to corroborate the findings of this systematic review.
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Affiliation(s)
- Maria Chicco
- From the Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, United Kingdom
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Commentary on: "Usefulness of Incisional Negative Pressure Wound Therapy for Decreasing Wound Complication Rates and Seroma Formation Following Prepectoral Breast Reconstruction". Aesthetic Plast Surg 2021; 45:1946-1949. [PMID: 33666737 DOI: 10.1007/s00266-021-02195-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
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Gilmour A, Cutress R, Gandhi A, Harcourt D, Little K, Mansell J, Murphy J, Pennery E, Tillett R, Vidya R, Martin L. Oncoplastic breast surgery: A guide to good practice. Eur J Surg Oncol 2021; 47:2272-2285. [PMID: 34001384 DOI: 10.1016/j.ejso.2021.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/18/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023] Open
Abstract
Oncoplastic Breast Surgery has become standard of care in the management of Breast Cancer patients. These guidelines written by an Expert Advisory Group; convened by the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), are designed to provide all members of the breast cancer multidisciplinary team (MDT) with guidance on the best breast surgical oncoplastic and reconstructive practice at each stage of a patient's journey, based on current evidence. It is hoped they will also be of benefit to the wide range of professionals and service commissioners who are involved in this area of clinical practice.
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Affiliation(s)
- A Gilmour
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, United Kingdom
| | - R Cutress
- University of Southampton and University Hospital Southampton, United Kingdom
| | - A Gandhi
- Manchester Academic Health Sciences Centre & Manchester University Hospitals NHS Trust, Manchester, United Kingdom
| | - D Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - K Little
- Liverpool Breast Unit, Liverpool University Foundation Trust, United Kingdom
| | - J Mansell
- Gartnavel General Hospital, Glasgow, United Kingdom
| | - J Murphy
- Manchester University Hospitals NHS Trust, United Kingdom
| | | | - R Tillett
- Royal Devon and Exeter NHS Trust, Exeter, United Kingdom
| | - R Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - L Martin
- Liverpool Breast Unit, Liverpool University Foundation Trust, United Kingdom.
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Murphy JA, Myers D, Trueman P, Searle R. Cost-effectiveness of single-use negative-pressure therapy compared with standard care for prevention of reconstruction failure in prepectoral breast reconstruction. BJS Open 2021; 5:6220255. [PMID: 33839751 PMCID: PMC8038262 DOI: 10.1093/bjsopen/zraa042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background Single-use negative-pressure wound therapy (sNPWT) has been reported to reduce the incidence of reconstruction failure in prepectoral breast reconstruction compared with standard surgical dressings. The aim of this economic evaluation was to investigate the cost-effectiveness of sNPWT compared with standard care for the prevention of reconstruction failure in prepectoral breast reconstruction in the UK. Method A decision tree model was used to estimate the expected cost and effectiveness per patient. Effectiveness was measured both by the number of reconstruction failures avoided and the gain in quality-adjusted life-years (QALYs). The baseline incidence of reconstruction failure (8.6 per cent) was taken from a recently published study of 2655 mastectomies in the UK. The effectiveness of sNPWT used results from a clinical study comparing sNPWT with standard dressings. Previously published utility weights were applied. The cost of reconstruction failure was estimated from detailed resource data from patients with reconstruction failure, applying National Health Service reference costs. One-way, probabilistic, scenario and threshold analyses were conducted. Results The undiscounted cost per patient associated with reconstruction failure was estimated to be £23 628 (£22 431 discounted). The use of sNPWT was associated with an expected cost saving of £1706 per patient, an expected increase in QALYs of 0.0187 and an expected 0.0834 reconstruction failures avoided. Cost-effectiveness acceptability analysis demonstrated that, at a threshold of £20 000 per QALY, 99.94 per cent of the simulations showed sNPWT to be more cost-effective than standard care. Conclusion Among patients undergoing immediate prepectoral breast reconstruction, the use of sNPWT is more cost-effective than standard dressings.
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Affiliation(s)
- J A Murphy
- Nightingale Breast Unit, Manchester University NHS Foundation Trusts, Manchester, UK
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Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3312. [PMID: 33425618 PMCID: PMC7787276 DOI: 10.1097/gox.0000000000003312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
Background: This study sets out to compare reconstructive practice between patients undergoing immediate breast reconstruction (IBR) for cancer and those who opted for risk reduction (RR), with an emphasis on examining patterns of secondary surgery. Methods: Data collection was performed for patients undergoing mastectomy and IBR at a teaching hospital breast unit (2013–2016). Results: In total, 299 patients underwent IBR (76% cancer versus 24% RR). Implant-based IBR rate was similar in both groups (58% cancer versus 63% RR). Reconstruction loss (5.3% cancer versus 4.2% RR) and complication (16% cancer versus 12.9% RR) rates were similar. Cancer patients were more likely to undergo secondary surgery (68.4% versus 56.3%; P = 0.025), including contralateral symmetrization (22.8% versus 0%) and conversion to autologous reconstruction (5.7% versus 1.4%). Secondary surgeries were mostly planned for cancer patients (72% planned versus 28% unplanned), with rates unaffected by adjuvant therapies. This distribution was different in RR patients (51.3% planned versus 48.7% unplanned). The commonest secondary procedure was lipomodeling (19.7% cancer versus 23.9% RR). For cancer patients, complications resulted in a significantly higher unplanned secondary surgery rate (82.5% versus 38.8%; P = 0.001) than patients without complications. This was not evident in the RR patients, where complications did not lead to a significantly higher unplanned surgery rate (58.9% versus 35.2%; P = 0.086). Conclusions: Most of the secondary surgeries were planned for cancer patients. However, complications led to a significantly higher rate of unplanned secondary surgery. Approximately 1 in 4 RR patients received unplanned secondary surgery, which may be driven by the desire to achieve an optimal aesthetic outcome.
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Mangialardi ML, Salgarello M, Cacciatore P, Baldelli I, Raposio E. Complication Rate of Prepectoral Implant-based Breast Reconstruction Using Human Acellular Dermal Matrices. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3235. [PMID: 33425578 PMCID: PMC7787273 DOI: 10.1097/gox.0000000000003235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/14/2020] [Indexed: 04/10/2023]
Abstract
Implant-based breast reconstruction (IBR) is currently the most frequently performed reconstructive technique post mastectomy. Even though submuscular IBR continues to be the most commonly used technique, mastectomy technique optimization, the possibility to check skin viability with indocyanine green angiography, the enhanced propensity of patients undergoing prophylactic mastectomies, and the introduction of acellular dermal matrices (ADMs) have paved the way to the rediscovery of the subcutaneous reconstruction technique. The aim of this article is to update the complication rate of immediate and delayed prepectoral IBR using human ADMs (hADMs). METHODS A literature search, using PubMed, Medline, Cochrane, and Google Scholar database according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, was conducted to evaluate complication rates of prepectoral implant-based reconstructions using hADMs. The following MeSH terms were used: "prepectoral breast reconstruction acellular dermal matrix," "prepectoral breast reconstruction ADM," "human ADM breast reconstruction," and "human acellular dermal matrix breast reconstruction" (period: 2005-2020; the last search took place on April 2, 2020). RESULTS This meta-analysis includes 1425 patients (2270 breasts) who had undergone immediate or delayed prepectoral IBR using different types of hADMs. The overall complication rate amounted to 19%. The most frequent complication was represented by infection (7.9%), followed by seroma (4.8%), mastectomy flap necrosis (3.4%), and implant loss (2.8%). CONCLUSIONS The overall complication rate was 19%. The most frequent complications were infection, seroma, and mastectomy flap necrosis, while capsular contracture was rare.
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Affiliation(s)
- Maria Lucia Mangialardi
- From the Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, Rome 00168, Italy
| | - Marzia Salgarello
- From the Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, Rome 00168, Italy
| | - Pasquale Cacciatore
- From the Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito 1, Rome 00168, Italy
| | - Ilaria Baldelli
- Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate – DISC, Università degli Studi di Genova, L.go R. Benzi 10, 16132, Genova, Italy
| | - Edoardo Raposio
- Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate – DISC, Università degli Studi di Genova, L.go R. Benzi 10, 16132, Genova, Italy
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Comment on: "Negative Pressure Wound Therapy Reduces Wound Breakdown and Implant Loss in Prepectoral Breast Reconstruction". PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2908. [PMID: 32766058 PMCID: PMC7339230 DOI: 10.1097/gox.0000000000002908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
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