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- ItemAcesso aberto (Open Access)Application time for postoperative wound dressing following breast augmentation with implants: study protocol for a randomized controlled trial(Biomed Central Ltd, 2015-01-27) Mendes, Denise de Almeida [UNIFESP]; Veiga, Daniela Francescato [UNIFESP]; Veiga-Filho, Joel [UNIFESP]; Fonseca, Fernando Elias Martins; Paiva, Luiz Francisley de; Novo, Neil Ferreira; Loyola, Ana Beatriz Alkmin Teixeira; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Vale SapucaiBackground: Breast augmentation with silicone implants is one of the most frequently performed cosmetic surgeries worldwide. Surgical site infection (SSI) remains an important complication of this procedure. One of the most important risk factors for SSI is the presence of microorganisms on the skin surrounding the wound. Guidelines by the Centers for Disease Control (CDC) recommend that surgical wounds be covered with a sterile dressing for 24 to 48 hours. However, a recent study showed that the application of a dressing for six days after breast reduction reduced wound colonization by coagulase-negative staphylococci.Methods/Design: A randomized clinical trial was designed to assess two protocols of postoperative wound care to determine how the application duration of the postoperative dressing influences wound colonization in patients undergoing breast augmentation with silicone implants. Women aged between 18 and 60 years who are candidates for breast augmentation with silicone implants will be randomly allocated to group I (n = 48), in which the dressing will be removed on the first postoperative day, or group II (n = 48), in which the dressing will be removed on the sixth postoperative day. Cutaneous colonization will be assessed by cultures of samples of skin flora taken from the wound region. the incidence of SSI, using standardized CDC criteria, and the perceptions of patients towards the dressing will be secondary outcomes.Discussion: An important component of SSI prevention is to minimize all possible risk factors, and the application of postoperative dressing plays a key role in this endeavor. the results of this clinical trial may help to standardize postoperative wound care after breast augmentation with silicone implants.
- ItemAcesso aberto (Open Access)Dressing wear time after breast reconstruction: study protocol for a randomized controlled trial(Biomed Central Ltd, 2013-02-22) Veiga, Daniela Francescato [UNIFESP]; Veiga-Filho, Joel; Damasceno, Carlos Americo Veiga; Sales, Edilaine Maria Leci; Morais, Thiago Bezerra; Almeida, Wania Eliza; Novo, Neil Ferreira; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Vale do SapucaiBackground: One of the major risk variables for surgical site infection is wound management. Understanding infection risk factors for breast operations is essential in order to develop infection-prevention strategies and improve surgical outcomes. the aim of this trial is to assess the influence of dressing wear time on surgical site infection rates and skin colonization. Patients' perception at self-assessment will also be analyzed.Methods/Design: This is a two-arm randomized controlled trial. Two hundred breast cancer patients undergoing immediate or delayed breast reconstruction will be prospectively enrolled. Patients will be randomly allocated to group I (dressing removed on postoperative day one) or group II (dressing removed on postoperative day six). Surgical site infections will be defined by standard criteria from the Centers for Disease Control and Prevention (CDC). Skin colonization will be assessed by culture of samples collected at predefined time points. Patients will score dressing wear time with regard to safety, comfort and convenience.Discussion: the evidence to support dressing standards for breast surgery wounds is empiric and scarce. CDC recommends protecting, with a sterile dressing for 24 to 48 hours postoperatively, a primarily closed incision, but there is no recommendation to cover this kind of incision beyond 48 hours, or on the appropriate time to shower or bathe with an uncovered incision. the results of the ongoing trial may support standard recommendations regarding dressing wear time after breast reconstruction.
- ItemSomente MetadadadosInfluence of dressing application time after breast augmentation on cutaneous colonization: A randomized clinical trial(Elsevier Sci Ltd, 2018) Mendes, Denise de Almeida [UNIFESP]; Veiga, Daniela Francescato [UNIFESP]; Veiga-Filho, Joel [UNIFESP]; Loyola, A. B. A. T.; Paiva, L. F.; Novo, Neil Ferreira [UNIFESP]; Sabino Neto, Miguel [UNIFESP]; Ferreira, L. M. [UNIFESP]Concepts regarding the best way to treat a surgical wound vary, in literature, ranging from no dressing use to dressing maintenance for 24 to 48 hours or until suture removal. This study aimed to evaluate the influence of the length of dressing maintenance after breast augmentation with implants on cutaneous colonization and surgical site infection. This is a two-arm, parallel group, randomized clinical trial. Eighty patients who were candidates for augmentation mammoplasty with silicone implants were randomly allocated to two groups, in which the dressing was removed on postoperative day 1 (group A, n = 40) or postoperative day 6 (group B, n = 40). Cutaneous colonization was examined by culturing samples collected before and after dressing removal. The criteria defined by the Centers for Disease Control and Prevention were used to assess surgical site infection. No significant difference regarding cutaneous colonization was observed between groups before dressing application. On postoperative day 6, significantly more bacterial growth was observed in group A (p = 0.01). No surgical site infection occurred. We concluded that maintaining the dressing for 6 days led to a lower cutaneous colonization but did not influence surgical site infection rates. (c) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
- ItemAcesso aberto (Open Access)Tempo de permanência do curativo após mamoplastia redutora: influência na colonização, na infecção da ferida operatória e na opinião das pacientes(Universidade Federal de São Paulo (UNIFESP), 2010-08-25) Veiga Filho, Joel [UNIFESP]; Sabino Neto, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: There is controversy in the literature regarding the treatment of surgical wounds, which includes different approaches to wound management, such as “not to dress the wound” to “leave the dressing in place for 24-48 hours” or “until sutures are removed”. Objective: To evaluate the effect of the length of time the dressings were left in place after reduction mammaplasty on skin colonization, surgical site infection, and patient opinion. Methods: Seventy patients undergoing reduction mammaplasty were randomly divided into two groups: group PO1 (dressing was removed on the first postoperative day) and group PO6 (dressing was removed on the sixth postoperative day). Skin colonization was detected by culture of samples collected at predefined time points. Surgical site infections were classified according to the guidelines of the Centers for Disease Control and Prevention (CDC). Patient satisfaction was assessed on postoperative day 13. Results: A larger number of colony-forming units were measured in group PO1 on postoperative day 6. Nine (12.9%) patients had surgical site infection (seven from group PO1, and two from group PO2). In group PO1, 66% of the patients chose to keep the dressing for one day, while 83% of the patients in group PO6 chose to keep the dressing for six days. Conclusions: Higher colonization levels were observed in group PO1 on the sixth postoperative day. There was no difference in surgical site infection between groups. Most of the patients chose to keep the dressing in place for six days postoperatively, and felt it was safer.