ALGINATE versus NPWT in the Preparation of Surgical Excisions for an STSG: ATEC Trial.

A calcium alginate dressing (ALGINATE) and negative pressure wound therapy (NPWT) are frequently used to treat wounds which heal by secondary intention. This trial compared the healing efficacy and safety of these 2 treatments. METHODS: This randomized, non-inferiority trial enrolled patients who underwent skin excision (>30 cm2), which was left open to heal by secondary intention. They received ALGINATE or NPWT by a centralized randomization. Follow-up was performed weekly until optimal granulation tissue was obtained. The primary outcome was time to obtain optimal granulation tissue for a split thickness skin graft take (non-inferiority margin: 4 days). Secondary outcomes were occurrence of adverse events (AEs) and impact of the treatments on the patient's daily life. RESULTS: ALGINATE and NPWT were applied to 47 and 48 patients, respectively. The mean time to optimal granulation was 19.98 days (95% CI, 17.7-22.3) with ALGINATE and 20.54 (95% CI, 17.6-23.5) with NPWT. Between group difference was -0.56 days (95% CI -4.22 to 3.10). The non-inferiority of ALGINATE versus NPWT was demonstrated. No AE related to the treatment occurred with ALGINATE versus 14 AEs with NPWT. There was no difference in the impact of the treatments on the patient's daily life. CONCLUSION: This trial demonstrates that ALGINATE has a similar healing efficacy to that of NPWT and that is markedly better with regard to patient safety.

Incidence of breast implant rupture in a 12-year retrospective cohort: Evidence of quality discrepancy depending on the range.

BACKGROUND & OBJECTIVE: The majority of studies assessing the rupture rate of breast implants were performed by the breast implant manufacturing industry with questionable independence. After repetitive removals of ruptured implants from the same model, our team decided to assess the rupture rate and the estimated risk thereof for most of the silicone gel-filled implants we have used since they regained market approval in France in 2001. METHODS: Our study is a retrospective cohort of 809 patients operated in our University Hospital from 2001 to 2013 for cosmetic or reconstructive goals. We could track 1561 implants, 90% of them from the same manufacturer, Allergan (Irvine, CA, USA). For each of those, we gathered their exact reference, date of implantation, surgical approach, status, last follow-up visit or the eventual date, and cause of removal. RESULTS: Of 225 explanted devices, only 27 were ruptured, all from the Allergan brand. Risks of removal for rupture were estimated: 0.5% at 1000 days, 6% at 2000 days, and 14% at 3000 days. Risks were significantly different between the models from this same manufacturer. One of the range of macro-textured round implants showed risks of removal for rupture of 33% at 3000 days compared to 6% for the anatomically shaped range. CONCLUSIONS: These results suggest a qualitative discrepancy among the different ranges of breast implants of a single manufacturer within the same timeframe of implantation. To determine the in vivo lifespan of the implants that we use more precisely and sooner, we suggest that each removed implant should be analyzed for wear and tear, independently from the industry.

Posterior perineal reconstructions with "supra-fascial" lotus petal flaps.

BACKGROUND: The lotus petal flap procedure is widely used for vulvovaginal reconstructions after gynecologic resections, but its effectiveness for posterior perineal coverage and filling is not yet well defined. METHODS: We conducted a retrospective evaluation of 10 lotus petal flap procedures performed between 2010 and 2014. Six patients were operated upon with posterior transpositions of unilateral (n = 2) or bilateral (n = 4) supra-fascial flaps. The patient demographics, comorbidities, and previous surgical treatments were surveyed. The postoperative outcomes, including length of stay, time of healing, and complications, were analyzed. RESULTS: Lotus petal flaps were indicated for filling of the chronic perineal cavity (n = 4) and for skin resurfacing (n = 2). The mean patient age was 61.5 years, and four patients previously underwent radiotherapy. The total operative time was 2.2 h on average. No wound complications or flap necrosis instances occurred during the follow-up consultations, which occurred at a mean of 20.5 months. The hospital stay duration was 11.3 days, and the duration of healing was 35.2 days, on average. Each flap transposition achieved the sustainable perineal reconstruction goal. CONCLUSIONS: The supra-fascial lotus petal flap is an easy and safe procedure for posterior perineal reconstructions. Whether for an immediate or a delayed operation, unilateral or bilateral flap harvestings allow for effective coverage and filling. Furthermore, the donor-site morbidity remained low because the scars were hidden in the gluteal fold.