Dressing Wear Time after Breast Reconstruction: A Randomized Clinical Trial

<div><p>Background</p><p>The evidence to support dressing standards for breast surgery wounds is empiric and scarce.</p><p>Objective</p><p>This two-arm randomized clinical trial was designed to assess the effect of dressing wear time on surgical site infection (SSI) rates, skin colonization and patient perceptions.</p><p>Methods</p><p>A total of 200 breast cancer patients undergoing breast reconstruction were prospectively enrolled. Patients were randomly allocated to group I (dressing removed on the first postoperative day, n = 100) or group II (dressing removed on the sixth postoperative day, n = 100). SSIs were defined and classified according to criteria from the Centers for Disease Control and Prevention. Samples collected before placing the dressing and after 1 day (group I) and 6 days (both groups) were cultured for skin colonization assessments. Patients preferences and perceptions with regard to safety, comfort and convenience were recorded and analyzed.</p><p>Results</p><p>A total of 186 patients completed the follow-up. The global SSI rate was 4.5%. Six patients in group I and three in group II had SSI (p = 0.497). Before dressing, the groups were similar with regard to skin colonization. At the sixth day, there was a higher colonization by coagulase-negative staphylococci in group I (p<0.0001). Patients preferred to keep dressing for six days (p<0.0001), and considered this a safer choice (p<0.05).</p><p>Conclusions</p><p>Despite group I had a higher skin colonization by coagulase-negative staphylococci on the sixth postoperative day, there was no difference in SSI rates. Patients preferred keeping dressing for six days and considered it a safer choice.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT01148823" target="_blank">NCT01148823</a></p></div

CONSORT Flow Diagram [43]

<p>CONSORT Flow Diagram [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0166356#pone.0166356.ref043" target="_blank">43</a>]</p

Microorganisms growth in thioglycolate broth and glucose broth and comparison between group I and group II by Chi-square test

<p>Microorganisms growth in thioglycolate broth and glucose broth and comparison between group I and group II by Chi-square test</p

Perceptions of patients in group I (n = 82) and group II (n = 81) related to their dressing wear time

<p>Perceptions of patients in group I (n = 82) and group II (n = 81) related to their dressing wear time</p

Demographic and surgical variables of patients in both groups and comparison by Mann-Whitney U test

<p>Demographic and surgical variables of patients in both groups and comparison by Mann-Whitney U test</p

Skin colonization results

<p>Skin colonization results</p

Time and technique of breast reconstruction and comparison between group I and group II by Chi-square test

<p>Time and technique of breast reconstruction and comparison between group I and group II by Chi-square test</p

Patients’ preferences for dressing wear time and comparison between groups I and II by Chi-square test

<p>Patients’ preferences for dressing wear time and comparison between groups I and II by Chi-square test</p

Association between technique of breast reconstruction and SSI occurrence, in groups I and II and overall, by Chi-square test

<p>Association between technique of breast reconstruction and SSI occurrence, in groups I and II and overall, by Chi-square test</p

Table_2_Association among inflammaging, body composition, physical activity, and physical function tests in physically active women.docx

BackgroundInflammaging is a phenomenon that has been associated with the development and progression of sarcopenia and frailty syndrome. According to the literature, on the one side, the increase in body fat is associated with a systemic pro-inflammatory status, which consequently favors inflammaging, and on the other side, the regular practice of physical exercise can mitigate the development of this scenario. Therefore, here, we aimed to evaluate the association between inflammaging and physical factors, both body and functional, in a group of physically active older women.MethodsSeventy older women (mean age 72.66 ± 6.17 years) participated in this observational cross-sectional and were separated into the eutrophic, overweight, and obese groups. It was assessed: by bioimpedance—body fat percentage (Fat%) and total (Fat kg), skeletal muscle mass (muscle), and free fat mass both in percentage (FFM%) and total (FFMkg); by the International Physical Activity Questionnaire (IPAQ)—the time of moderate-intensity physical activity per week; by physical tests—handgrip (HG), sit-up-stand-on-the-chair in 5 repetitions (Sit-up) and vertical squat jump test (SJ); in addition to the determination of serum cytokine concentration (IL-6, TNF-α, IL-10, and IL-8), and also body mass index (BMI) and calf circumference (Calf).ResultsHigher FFM% and lower body fat (both kg and %) were found in the eutrophic group than in the other groups. The eutrophic group also performed more weekly physical activity, jumped higher, and presented not only higher serum IL-6 concentration but also an increased ratio of IL-10/IL-6, IL-10/TNF-α, IL-10/IL-8 as compared to the values found in the overweight group. The obese group presented higher body fat (kg and %) and lower FFM% than the other groups and also higher serum IL-6 concentration than the overweight group. Interestingly, several significant negative and positive correlations between body composition, physical tests, and serum cytokine concentrations were found in the eutrophic and obese groups.ConclusionWhile the eutrophic older women group showed a remarkable regulation of the systemic inflammatory status with positive associations in the physical parameters assessed, the overweight and obese groups presented impairment regulations of the inflammaging, which could be related to less weekly physical activity and higher body fat.</p