Dataset Information

Barbed Ribbon Device for Progressive Tension Closure Reduces Seroma After Breast Reconstruction.

ABSTRACT:

Purpose

Implant-based breast reconstruction is fraught with complications related to seroma formation. Soft tissue stabilization with progressive tension closure (PTC) has been shown to decrease seroma formation after various procedures but is less suitable for mastectomy flap stabilization. We evaluate the incidence of seroma in breast reconstruction using bioabsorbable barbed ribbon devices (BRDs) as a novel approach to PTC.

Methods

We performed a retrospective review of all patients whose mastectomy flaps were stabilized with BRDs. These patients were compared with consecutive patients who underwent mastectomy and reconstruction without progressive tension flap stabilization. Patient demographics and outcomes were recorded, including comorbidities, complications, presence of seroma, and total drain days.

Results

In the BRD-PTC group, there were 36 breasts compared with 56 in the nonstabilized control group. There were no significant differences in rate of tobacco use, age, or body mass index. We identified 11 seromas in the control group (19.6%) and none in the intervention group (P = 0.05). In the PTC group, drains were removed an average of 5 days sooner than those in controls (P = 0.006).

Conclusion

Progressive tension stabilization of mastectomy flaps with BRD significantly reduces seroma formation and the duration for which closed suction drainage is required.

SUBMITTER: Griner D

PROVIDER: S-EPMC5690306 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Publications

Barbed Ribbon Device for Progressive Tension Closure Reduces Seroma After Breast Reconstruction.

Griner Devan D Steffen Caleb M CM Day Kristopher M KM Brzezienski Mark A MA

Annals of plastic surgery 20171201 6

<h4>Purpose</h4>Implant-based breast reconstruction is fraught with complications related to seroma formation. Soft tissue stabilization with progressive tension closure (PTC) has been shown to decrease seroma formation after various procedures but is less suitable for mastectomy flap stabilization. We evaluate the incidence of seroma in breast reconstruction using bioabsorbable barbed ribbon devices (BRDs) as a novel approach to PTC.<h4>Methods</h4>We performed a retrospective review of all pat ...[more]

PMID: 28857777

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Project description:BACKGROUND:Wound closure is one of the crucial aspects of total knee arthroplasty (TKA) for patients who perform high-flexion activities of daily living, because the joint capsule is highly stretched and integrity of the arthrotomy closure must be maintained. Watertightness of the knee joint is a different aspect of the repair integrity of arthrotomy closure and is being noticed with increasing usage of the drain clamp method for blood management after TKA. Recently, the barbed knotless suture has been growing in popularity as a strong, secure closure appropriate for high-tension areas, such as the fascia and joint capsule. The purpose of this study was to compare the barbed knotless suture with simple interrupted suture in cadaveric knees. METHODS:Nine fresh-frozen cadaveric lower extremities were used. After placing a parapatellar incision and setting a closed suction drain, arthrotomies were closed randomly using three suture materials: simple interrupted absorbable suture (No. 0 PDS, group C); or a single running knotless barbed suture Stratafix with 8N (group BS-8N) or 15N (group BS-15N) of tension. After arthrotomy closure, saline was injected in a retrograde manner into the joint through a drain until saline started to leak from the joint. Peak values for intra-articular pressure and infusion volume in each group were recorded and compared. RESULTS:Mean infusion volumes were 13.0?±?7.2?ml, 38.6?±?10.7?ml, and 5.1?±?2.5?ml in groups BS-8N, BS-15N, and C, respectively. Mean intra-articular pressures were 0.67?±?0.47?kPa, 9.44?±?4.55?kPa, and 0.56?±?0.44?kPa in groups BS-8N, BS-15N, and C, respectively. Infusion volume and joint internal pressure were significantly higher in group BS-15N than in groups BS-8N (p =?0.008) or C (p =?0.04). CONCLUSIONS:Barbed suture with 15N appears appropriate for maintaining maximal watertightness after knee joint capsule closure, offering successful drain clamping, higher resistance to early mobilization protocols, and subsequent achievement of early deep knee flexion after TKA.

Project description:The goal of this study was to assess the frequency and predictors of vascular closure device (VCD) deployment failure, and its association with vascular complications of 3 commonly used VCDs.VCDs are commonly used following percutaneous coronary intervention on the basis of studies demonstrating reduced time to ambulation, increased patient comfort, and possible reduction in vascular complications as compared with manual compression. However, limited data are available on the frequency and predictors of VCD failure, and the association of deployment failure with vascular complications.From a de-identified dataset provided by Massachusetts Department of Health, 23,813 consecutive interventional coronary procedures that used either a collagen plug-based (n = 18,533), a nitinol clip-based (n = 2,284), or a suture-based (n = 2,996) VCD between June 2005 and December 2007 were identified. The authors defined VCD failure as unsuccessful deployment or failure to achieve immediate access site hemostasis.Among 23,813 procedures, the VCD failed in 781 (3.3%) procedures (2.1% of collagen plug-based, 6.1% of suture-based, 9.5% of nitinol clip-based VCDs). Patients with VCD failure had an excess risk of "any" (7.7% vs. 2.8%; p < 0.001), major (3.3% vs. 0.8%; p < 0.001), or minor (5.8% vs. 2.1%; p < 0.001) vascular complications compared with successful VCD deployment. In a propensity score-adjusted analysis, when compared with collagen plug-based VCD (reference odds ratio [OR] = 1.0), nitinol clip-based VCD had 2-fold increased risk (OR: 2.0, 95% confidence interval [CI]: 1.8 to 2.3, p < 0.001) and suture-based VCD had 1.25-fold increased risk (OR: 1.25, 95% CI: 1.2 to 1.3, p < 0.001) for VCD failure. VCD failure was a significant predictor of subsequent vascular complications for both collagen plug-based VCD and nitinol clip-based VCD, but not for suture-based VCD.VCD failure rates vary depending upon the type of VCD used and are associated with significantly higher vascular complications as compared with deployment successes.

Dataset Information

Barbed Ribbon Device for Progressive Tension Closure Reduces Seroma After Breast Reconstruction.

Purpose

Methods

Results

Conclusion

Publications

Barbed Ribbon Device for Progressive Tension Closure Reduces Seroma After Breast Reconstruction.

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