The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center Study
Background:. Breast prosthesis infections are challenging and traditionally managed with prosthesis removal and delayed reconstruction. Single-application negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown promise for salvaging infected implants, though prior studies hav...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2025-01-01
|
| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006467 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832589614687191040 |
|---|---|
| author | Jason C. Llaneras, MD Robert Craig Clark, MD Lauren Antognoli, MD Emily Finkelstein, MD Luci Hulsman, BS Luther Holton, MD Devinder Singh, MD R. Jason VonderHaar, MD Risal Djohan, MD Aladdin H. Hassanein, MD Chris M. Reid, MD |
| author_facet | Jason C. Llaneras, MD Robert Craig Clark, MD Lauren Antognoli, MD Emily Finkelstein, MD Luci Hulsman, BS Luther Holton, MD Devinder Singh, MD R. Jason VonderHaar, MD Risal Djohan, MD Aladdin H. Hassanein, MD Chris M. Reid, MD |
| author_sort | Jason C. Llaneras, MD |
| collection | DOAJ |
| description | Background:. Breast prosthesis infections are challenging and traditionally managed with prosthesis removal and delayed reconstruction. Single-application negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown promise for salvaging infected implants, though prior studies have been small and heterogeneous. This study analyzes outcomes and compares protocols from four institutions.
Methods:. Data were collected on 56 patients (59 breasts) who underwent NPWTi-d salvage for peri-prosthetic infections. Patients with fewer than 3 months of follow-up were excluded. Salvage protocols included explantation, NPWTi-d application, antibiotics, and replantation. Successful salvage was defined as prosthesis retention without further explantation for at least 90 days posttreatment.
Results:. Intervention occurred on average 66 days after the index procedure. Methicillin-resistant organisms were cultured in 15% of cases. NPWTi-d was applied for an average of 61 hours with dwell times of 18 minutes every 3 hours, using institution-specific instillates. All patients were discharged with new prostheses (65% expanders, 35% implants) after an average hospital stay of 4 days. At 90-day follow-up, 71% of patients had no further complications, and 85% were successfully salvaged.
Conclusions:. This is the largest study to evaluate NPWTi-d for salvaging infected breast prostheses. The high success rate highlights the method’s efficacy, safety, and potential for preserving reconstruction. These straightforward protocols can significantly improve patient outcomes and reduce healthcare costs, offering a valuable option for managing prosthesis infections. |
| format | Article |
| id | doaj-art-2ea3a288e79d4d348804159ca1d329b3 |
| institution | Kabale University |
| issn | 2169-7574 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj-art-2ea3a288e79d4d348804159ca1d329b32025-01-24T09:19:58ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742025-01-01131e646710.1097/GOX.0000000000006467202501000-00036The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center StudyJason C. Llaneras, MD0Robert Craig Clark, MD1Lauren Antognoli, MD2Emily Finkelstein, MD3Luci Hulsman, BS4Luther Holton, MD5Devinder Singh, MD6R. Jason VonderHaar, MD7Risal Djohan, MD8Aladdin H. Hassanein, MD9Chris M. Reid, MD10From the * Division of Plastic Surgery, UC San Diego Health, San Diego, CAFrom the * Division of Plastic Surgery, UC San Diego Health, San Diego, CA† Division of Plastic Surgery, University of Miami, Miami, FL† Division of Plastic Surgery, University of Miami, Miami, FL‡ Division of Plastic Surgery, Indiana University, Indianapolis, IN§ Division of Plastic Surgery, Novant New Hanover Regional Medical Center, Wilmington, NC† Division of Plastic Surgery, University of Miami, Miami, FL‡ Division of Plastic Surgery, Indiana University, Indianapolis, IN¶ Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH.‡ Division of Plastic Surgery, Indiana University, Indianapolis, INFrom the * Division of Plastic Surgery, UC San Diego Health, San Diego, CABackground:. Breast prosthesis infections are challenging and traditionally managed with prosthesis removal and delayed reconstruction. Single-application negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown promise for salvaging infected implants, though prior studies have been small and heterogeneous. This study analyzes outcomes and compares protocols from four institutions. Methods:. Data were collected on 56 patients (59 breasts) who underwent NPWTi-d salvage for peri-prosthetic infections. Patients with fewer than 3 months of follow-up were excluded. Salvage protocols included explantation, NPWTi-d application, antibiotics, and replantation. Successful salvage was defined as prosthesis retention without further explantation for at least 90 days posttreatment. Results:. Intervention occurred on average 66 days after the index procedure. Methicillin-resistant organisms were cultured in 15% of cases. NPWTi-d was applied for an average of 61 hours with dwell times of 18 minutes every 3 hours, using institution-specific instillates. All patients were discharged with new prostheses (65% expanders, 35% implants) after an average hospital stay of 4 days. At 90-day follow-up, 71% of patients had no further complications, and 85% were successfully salvaged. Conclusions:. This is the largest study to evaluate NPWTi-d for salvaging infected breast prostheses. The high success rate highlights the method’s efficacy, safety, and potential for preserving reconstruction. These straightforward protocols can significantly improve patient outcomes and reduce healthcare costs, offering a valuable option for managing prosthesis infections.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006467 |
| spellingShingle | Jason C. Llaneras, MD Robert Craig Clark, MD Lauren Antognoli, MD Emily Finkelstein, MD Luci Hulsman, BS Luther Holton, MD Devinder Singh, MD R. Jason VonderHaar, MD Risal Djohan, MD Aladdin H. Hassanein, MD Chris M. Reid, MD The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center Study Plastic and Reconstructive Surgery, Global Open |
| title | The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center Study |
| title_full | The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center Study |
| title_fullStr | The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center Study |
| title_full_unstemmed | The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center Study |
| title_short | The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center Study |
| title_sort | efficacy of single application npwti d for the salvage of infected breast prostheses a multi center study |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006467 |
| work_keys_str_mv | AT jasoncllanerasmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT robertcraigclarkmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT laurenantognolimd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT emilyfinkelsteinmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT lucihulsmanbs theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT lutherholtonmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT devindersinghmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT rjasonvonderhaarmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT risaldjohanmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT aladdinhhassaneinmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT chrismreidmd theefficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT jasoncllanerasmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT robertcraigclarkmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT laurenantognolimd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT emilyfinkelsteinmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT lucihulsmanbs efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT lutherholtonmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT devindersinghmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT rjasonvonderhaarmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT risaldjohanmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT aladdinhhassaneinmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy AT chrismreidmd efficacyofsingleapplicationnpwtidforthesalvageofinfectedbreastprosthesesamulticenterstudy |