Risk of breast implant bacterial contamination from endogenous breast flora, prevention with nipple shields, and implications for biofilm formation.

BACKGROUND: Capsular contracture (CC) is a common complication of breast augmentation that is thought to arise from bacterial contamination and subsequent biofilm formation on the implant. Endogenous breast flora expressed through the nipple may contaminate the sterile field during breast augmentation, acting as a possible source for initiation of biofilm formation. OBJECTIVES: The authors investigate the incidence of nipple bacterial contamination with endogenous breast flora after standard chest wall sterilization during breast augmentation. METHODS: Bacterial contamination of nipples and nipple shields was assessed in a series of 32 consecutive patients presenting for breast augmentation (63 breasts: 31 bilateral procedures and 1 unilateral procedure). After standard sterilization of the chest wall, occlusive nipple shields were applied and breast augmentation was performed. At the conclusion of breast augmentation, the nipple shields were removed and, using the same swab, both the nipple/areolar area and occlusive dressings were cultured. RESULTS: Data from 63 cultured nipples and nipple shields revealed that 22 nipples/nipple shields (34.9%) were positive for bacterial contamination. Three patients, all of whom had negative cultures, developed CC after augmentation. CONCLUSIONS: The exposed nipple is a potential source of implant contamination during breast augmentation. An improved understanding of biofilms and related risk factors for CC can provide surgeons with insights for addressing this common complication. Meticulous hemostasis, use of nipple shields, and submuscular device placement may contribute to a lower incidence of CC.

Special considerations in vascular anomalies: operative management of craniofacial osseous lesions.

The treatment of vascular anomalies of the head and neck typically focuses on restoration of abnormal structures of the soft tissues. However, vascular anomalies can affect the craniofacial skeleton, and osseous reconstruction may be indicated. Osseous involvement occurs as either a primary or secondary phenomenon. In primary osseous involvement, the vascular anomaly expands the bone from within. Secondary osseous involvement occurs when bony hypertrophy develops because of increased flow of the surrounding soft tissue. This article focuses on the management of the osseous deformities associated with vascular anomalies.

Unusual case of right-sided May-Thurner syndrome and review of its management.

May-Thurner syndrome is a phenomenon commonly described as an acquired stenosis of the left common iliac vein as a result of right common iliac artery compression. We report an unusual case of right-sided May-Thurner syndrome in a patient found to have a left-sided inferior vena cava. We also review the management of this patient using angioplasty, intraoperative thrombolysis, and endoluminal stent placement.

Management and short-term patency of lower extremity venous injuries with various repairs.

BACKGROUND: Although several methods of repair of extremity venous injuries have been shown to be efficacious, patency rates have varied significantly from center to center. METHODS: A retrospective review was made of treatment outcomes of adult and pediatric patients with major venous injuries of the lower extremity. RESULTS: From 1997 to 2002, 82 patients sustained 86 major lower extremity venous injuries. Venous injuries were treated with primary repair in 27, complex repair in 37 (autogenous vein, 10, and ringed polytetrafluoroethylene [PTFE], 27) and ligation in 20. Prior to repair, temporary intraluminal venous shunts were used in 18 patients. Follow-up duplex imaging or venography or both were performed on 42 extremities at a mean of 10.9 +/- 7.1 days after repair with an overall patency rate of 73.8% (primary repair 76.5%; autogenous vein graft 66.7%; and PTFE 73.7%). CONCLUSIONS: Overall early patency rate of venous repairs performed by an experienced trauma team is similar irrespective of the type of repair. The use of temporary intraluminal shunts is acceptable in selected circumstances, while ringed PTFE grafts are reasonable alternatives when the contralateral saphenous vein is too small.