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

Discussion

Wound dehiscence, defined as significant wound breakdown which results in delayed healing (greater than 2 weeks),[16] remains one of the most common complications after a breast reduction procedure. It constitutes a grievous complication for the patient and the surgeon. The patient, who has made a venerable financial investment, anticipates quick and aesthetically pleasing results and instead has to deal with an open wound in her breast. Based on the accumulative experience of the authors as aesthetic and reconstructive surgeons, this is usually accompanied by psychological stress, affecting both the patient and the surgeon. A treatment modality that can precipitate the healing of the wound, both in terms of filling the depressed wound, as well as expediting reepithelialization, is paramount.

Wound dehiscence, especially at the inverted T junction, depends on various factors, the most important being wound infection and tension of the wound edges.[14] These factors interfere with normal wound healing by disturbing the physiological cellular continuity of events and the tension-induced arterial and venous vascular compromise. Risk factors for wound dehiscence include smoking, obesity,[13] increased resection weights, and lengthened anesthetic times.[24]

Current literature on the management of wound dehiscence is limited at best and prospective management options are intensively sought by plastic surgeons encountering these common complications. Healing by secondary intention is mostly suitable for small areas of dehiscence along the flap edge. These are termed partial dehiscence, (ie, T-junction breakdown), and generally heal without complication.[13,17] Other reported modalities include application of certain antibiotic preparations, in case of a precipitating infection, and moist wound dressings[16] and conservative surgical debridement of the small amounts of devitalized tissue.[17] Other reported options for the management of acute open wounds utilize other dressing regimens including silver-hydrofiber dressing (eg, Aquacel Ag, ConvaTec, Skillman, NJ),[18] and the use of negative pressure therapy.[19] When total dehiscence occurs, (ie, dehiscence involving larger areas than the T-junction) further operative procedures are sometimes required.[16] A surgical intervention in these instances is undesirable due to the tension needed to primarily close the wound edges and a high recurrence rate of wound dehiscence.

This study presents 5 patients with wound dehiscence following a breast reduction procedure that was successfully treated with CPM in the Department of Plastic and Reconstructive Surgery at the Sheba Medical Center, Tel-Aviv, Israel. Albeit a feasibility study with no control cases or cost analysis, the results were clinically apparent. Except for 1 patient, wound closure was clinically and visibly expedited with the use of CPM. The application of CPM was rather simple, painless, and had no apparent complications, thus rendering it as an appealing treatment option. The authors have witnessed marked promotion of granulation tissue formation in wound beds and swift epithelization rates with CPM treatment. The promotion of granulation tissue formation in wound beds aided in filling the depressed wound beds and leveled out the scar formation plane with adjacent flaps. The fact that these effects were visible, coupled with daily improvement witnessed by both physicians and patients, aided in alleviating the psychological stress of these patients. Even though in all cases the resulting scars became progressively smaller due to scar contracture, they remained as a visible remnant of the complication. The treatment with CPM did not, in the authors minds, help achieve cosmetically appealing scars, even though it prevented the development of depressed scars. The resulting scars were, in the authors' opinion, quite similar in appearance to postoperative scars that would have been achieved with skin grafting. While skin grafting could, arguably, have promoted slightly faster results, avoiding additional surgery with its accompanying donor site scarring/pigmentation changes is paramount in this patient population (ie, the elective aesthetic patient). The patients were happy with the resulting scars and did not wish for further scar revision; but it is plausible that some of these scars will require further management later on. As there is no perfect solution for any wound, patient 4, being a heavy smoker, had no marked clinical response to the CPM treatment. That patient's wound epithelialization rate was less than a quarter of the average epithelialization rate of the other 4 patients (0.5 mm compared to 2.25 mm per day).

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