Omar, Mohamed

Abstract Goals/Purpose Patients with adjuvant radiotherapy are significantly more likely to have complications such as infections and wound dehiscence following breast surgery.1 Closed incision negative pressure wound therapy (cINPT) holds incision edges together, prevents external contamination and removes exudate, promoting tensile strength and increased collagen recruitment at the incision site compared to the standard of care dressings.2 cINPT is helpful in surgical closures on high-risk patients.3 We evaluated the complication rates following the use of cINPT in implant-based breast reconstruction. Methods/Technique A cohort was collected retrospectively from a single institution, from January 1, 2018 to October 31 2022. The complication rates were then compared between cINPT dressing and standard-of-care dressings on radiated patients following breast surgery. Results/Complications The data collected consist of a total of 83 radiated breasts that underwent implant based reconstruction. cINPT was used in 41 breasts and standard-of-care dressings were used in 42 breasts. Of the cINPT cohort, 2 patients developed seromas that required bedside aspirations (4.8%) and one patient developed an infection (2.4%) with none of the patients requiring re operations. Of the standard of care dressings cohort, 9 patients developed seromas (21.4%), and 3 patients developed infections (7.1%), of which 3 patients required reoperations (7.1%). Conclusion Patients with prior radiation who received cINPT had lower risk of developing complications compared to patients with prior radiation who received standard-of-care dressings.

Abstract The principles of achieving an aesthetically pleasing and harmonious facial appearance are influenced by our evolving understanding of the three-dimensional topography of the face coupled with novel approaches to midface volumization and contouring. In parallel with the evolving landscape of facial aesthetic surgery, an increasing number of publications have emerged focusing on the role of intraoral buccal fat pad removal (BFPR) for the purposes of aesthetic midface contouring. The authors sought to emphasize an underreported and potentially preventable and untoward complication involving iatrogenic parotid duct injury following BFPR. The purpose of this publication is 3-fold: (1) to review the relevant anatomy and literature on intraoral BFPR, (2) to present a case example of this complication, and (3) to discuss treatment options as part of a proposed management algorithm. The authors detail the surgical indications for performing BFPR and review the relevant anatomic considerations. Complication prevention strategies are outlined, and details regarding avoidance of parotid duct injury are reviewed. The diagnostic criteria and clinical presentation of parotid duct injuries following BFPR are comprehensively outlined. The authors present a clinically actionable algorithm for managing a suspected or diagnosed parotid duct injury following BFPR. A clinical case example is discussed to highlight this complication, the diagnostic criteria, and the systematic and algorithmic approach to management. Intraoral BFPR is an incredibly valuable and powerful procedure that can improve facial contour in patients with buccal lipodystrophy or buccal fat pad pseudoherniation. The authors propose a proper diagnostic approach and treatment algorithm to manage this untoward complication. Level of Evidence: 5