ABSTRACT
Latex gloves are used by surgical staff to avoid exposure to patient body fluids, thus reducing the risk of contracting bloodborne viral diseases, such as hepatitis C and HIV. We studied the efficacy of the surgical barrier provided by latex gloves, before and after use in the operating theater. The electrical conductivity, insulation and mechanical resistance of glove latex were investigated, using routine supplies of surgical gloves. Latex structure was assessed by scanning electron microscopy and by mercury intrusion porosimetry. Latex is subject to hydration, a phenomenon associated in the laboratory with the loss of its electrical insulation properties. Such glove latex properties were found to be highly variable, with latex hydration times varying between 2 and more than 30 min. Rapidly hydrating gloves showed increased permeability to methylene blue, associated with higher levels of porosity. Thirty min of surgical use was associated with measurable hydration of glove latex and a statistically significant loss of electrical and mechanical resistance, with rupture load decreasing by 24%. Electronic control of the insulation properties of gloves during surgery permits early detection of hydration, and allows prompt correction by glove change, before the gloves lose their electrical and mechanical competence.
ABSTRACT
Exposure of silicone breast implants may occur as a result of hematoma and infection, inadequate soft tissue coverage, use of steroids, or trauma. In various series the incidence of severe complications is reported to range from 1% to 4%. When exposure of the implant has occurred, most authors recommend removal with replacement four to six months later. In 11 patients we successfully salvaged the exposed breast implant. The technique was initially presented in 5 patients in 1974. Successful salvage of the exposed implant involved (1) wound cultures with preoperative and postoperative antibiotic therapy, (2) excisional debridement of the skin wound, (3) open capsulotomy to relieve tension, (4) wound irrigation with neomycin-polymyxin or povidone-iodine, (5) closed catheter drainage, and (6) replacement with a sterile prosthesis. Secondary closure of these wounds was successful in all of the patients. Of the 11 patients, 9 were seen at two years postoperatively with results comparable in appearance and softness to the opposite breast. One of the patients required subsequent bilateral capsulotomies for firmness. The use of this technique is recommended for selected patients in whom there are no systemic problems related to wound healing and in whom sufficient soft tissue coverage is possible.
