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

Results

From 2009 to 2011, 5 female patients who had undergone breast reduction or mastopexy augmentation procedures presented to the Department of Plastic and Reconstructive Surgery at the Sheba Medical Center, Tel-Aviv, Israel, with wound dehiscence of their surgical scar. They were subsequently hospitalized and treated daily with CPM-soaked dressings as previously described. Table 1 shows patients ages and surgical procedure; duration of open wounds prior to the CPM regimen and previously attempted dressing regimens; CPM treatment duration; and average epithelialization rates calculated from daily wound dimension measurements. This Table also shows reported local pain before and during the CPM dressing regimen (graded by patients on a scale of 1 (no pain) to 10 (extreme pain), and patients' satisfaction from the CPM dressing regimen (graded by patients on a scale of 1 (not at all satisfied) to 10 (extremely satisfied)

Average patient age was 41.4 years (range 28–53). Three patients were heavy smokers while the other 2 did not smoke. Patient 5 received a long-term oral steroid regimen due to persistent asthma with subsequent diabetes mellitus. She underwent a bilateral facelift and a revision of a mastopexy augmentation, and presented with dehiscence of wounds in both breasts and postauricular suture lines. This patient was advised to take vitamin A supplements to negate the negative effect of the oral steroid regimen. Clinically, patients 1, 2, 3, and 5 had a marked response to the treatment regimen, while patient 4's wound failed to respond in such a swift manner, and required about 22 weeks of treatment to achieve complete closure (Table 1). It should be noted that patient 4 was a heavy smoker and that her wound was open for almost thrice the average duration of the other patient's wounds (70 days vs 24.7 days). Average wound duration prior to the CPM therapy for all 5 patients was 33.8 days (range 14–70 days). Average CPM treatment duration was 50.4 days including patient 4, and 24 days not including (range 17–156 days). Average wound epithelialization rate was 1.9 mm per day including patient 4, and 2.25 mm per day not including (range 0.5–2.6 millimeters). Figure 1 and Figure 2 demonstrate the typical clinical response and epithelialization rate related to the CPM dressing regimen. There were no documented adverse reactions, wound infections, or allergic reactions during the treatment. Patients did not report pain in the wound area during dressing changes. When comparing local pain symptoms with the CPM treatment regimen compared to previously attempted modalities, 3 patients had no local pain before the CPM regimen or during it, while the other 2 patients had some local pain before the CPM regimen that had markedly improved during the CPM treatment regimen. This finding, while encouraging, is obviously not significant due to the temporal nature of subsequent treatment regimens. All patients reported extreme satisfaction from the CPM treatment and its results. Average follow-up was 23 months (range 14–45 months).

Figure 1.

Left to right: Patient 1 before treatment with charged polystyrene microspheres; day 5; day 10; and day 17 of treatment.

Figure 2.

Left to right: Patient 2 before treatment with charged polystyrene microspheres; day 5; day 12; and day 24 of treatment.

processing....