Treatment of Wounds Following Breast Reduction and Mastopexy With Subsequent Wound Dehiscence With Charged Polystyrene Microspheres

Oren Weissman, MD; Eyal Winkler, MD; Luc Teot, MD, PhD; Eric Remer, MD; Nimrod Farber, MD; Jonathan Bank, MD; Gabriel Hundeshagen, BMedSc; Isaac Zilinsky, MD; Josef Haik, MD, MPH

Disclosures

Wounds. 2014;26(2):37-42. 

In This Article

Abstract and Introduction

Abstract

Background. Lower T-junction wound dehiscence following breast reduction surgery or mastopexy constitutes a vexing and grievous complication both to the surgeon and the patient. Treatment modalities that can expedite wound healing and reepithelialization rates are highly craved. The objective of this study was to assess wound healing and epithelialization rates of open wounds following breast reduction and mastopexy wound dehiscence treated with charged polystyrene microspheres (CPM).

Materials and Methods. Five female patients with wound dehiscence and subsequent open wounds following breast reduction and mastopexy were treated with daily with CPM-soaked dressings. Wound closure rates were documented.

Results. The wounds showed both accelerated granulation tissue formation as well as swift epithelialization rates. No complications or side effects were encountered.

Conclusions. Charged polystyrene microspheres may offer a new and efficacious way to heal open wounds due to wound dehiscence following aesthetic breast surgery. Further research with a larger patient population is still needed to verify these findings.

Introduction

Breast reduction surgery is one of the most commonly performed procedures in plastic surgery. According to the American Society of Plastic Surgeons (ASPS), in 2009, 78,427 breast reduction procedures were performed in the United States alone.[1] The benefits of this procedure are well-documented with studies demonstrating long-term improvements in physical and psychological well being.[2–4] One of the most commonly practiced techniques for breast reduction relies on an inferiorly based pedicle for the nipple areolar complex introduced between 1975 and 1977 by Ribeiro,[5] Robbins,[6] and Courtiss and Goldwyn.[7] In this technique, the skin is usually removed in the Wise pattern which results in an inverted T scar in the inframammary fold. Even when using other techniques, such as the supero-medial pedicle with a keyhole shaped skin incision, an inverted T scar is sometimes needed to remove excess skin and manage the resulting "dog ears," the skin and subcutaneous fat excess that is usually the result of flap rotation or advancement, frequently necessitating its excision, resulting in an additional scar.

Common complications of this procedure include wound dehiscence, hematoma or seroma formation, wound infection, fat necrosis, stitch abscesses, diminished nipple sensation, hypertrophic scarring, and sometimes skin and/or nipple-areola necrosis.[8–13] From all the aforementioned complications, delayed wound healing and wound dehiscence are the most common, with a reported incidence for the latter of approximately 10%.[13–15] This aforementioned dehiscence usually occurs in the convergence of the flaps in the inverted T skin scar, where the tension on the skin flaps is usually the highest. Wound dehiscence constitutes a vexing complication to both the patient and the surgeon, thus swift resolution of these open wounds is in the best interest of both sides. Existing literature regarding the management of the consequent open wound following wound dehiscence includes healing by secondary intention, local antibiotic preparations, moist dressings, hydrofiber dressings, and the application of topical negative pressure dressings.[13,16–19] Still, even with the abundance of existing wound dressing solutions, the authors have yet to encounter a product or dressing regime that clearly accelerates epithelization rates.

Recently, a new product emerged claiming to expedite wound healing. This product (Polyheal-1, Polyheal Ltd, Yavneh, Israel) is a water-based sterile 0.025% suspension of charged polystyrene microspheres (CPM) with a size of 5 microns in a nutritional medium. Evidence suggests it is the size and surface properties of the charged beads that contribute to the provision of a supportive, healing microenvironment on the wound surface by serving as an additional surface for the attachment and migration of epithelial, endothelial, and inflammatory cells, including mast cells.[20,21] Polystyrene microspheres have been shown to induce a pulmonary inflammatory process in rabbits, through enhancement of the release of inflammatory mediators such as substance P and histamine.[22] Charged polystyrene microspheres have been shown to accelerate the healing rates of chronic wounds of different etiologies as well as to promote accelerated granulation tissue appearance.[23] The company claims that in vitro and in vivo testing demonstrated the charged microspheres activate different types of cells in the wound bed (eg, inflammatory cells, fibroblasts, and keratinocytes), hence promoting the initiation of granulation tissue growth and remodeling of damaged skin tissue.

The objective of this study was to assess the feasibility of using CPM for open wounds, resulting from post-breast reduction and post-mastopexy wound dehiscence in terms of wound healing and epithelization rates.

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