A Board Certified Plastic Surgeon in Scottsdale
Posts tagged Medical Technology
My Prineo Evaluation Continues…
01 year ago
In the O.R. with Prineo.
Scottsdale – As I continue to evaluate Prineo, the new combination mesh tape and Dermabond® surgical glue, I continue to learn about this new product and how it performs. In the last few weeks, my plastic surgery patients with Prineo, have demonstrated very good results at the incision lines. In follow up appointments I have learned a few more useful tips about the mesh-glue technique.
Easy in Plastic Surgery Procedures
First of all, with a little practice, it is easy to put on and it is easy to remove. The simplest removal technique, for patient and plastic surgeon, is to use petrolatum over the mesh-glue. I recommend for the cosmetic surgery patient to begin applying either Vaseline® or Bacitracin ointment 48 to 72 hours before their scheduled appointment.
I learned not to apply the petrolatum too early! If this is applied much earlier than 72 hours, the reaction will progress and the mesh-glue will become loose. The patient will be tempted to remove it at home. This experience helped me to develop a quick and easy statement I regularly share with patients, “He who puts it on, takes it off”. This has helped to avoid situations in which the patient removes the mesh-glue on their own.
Recommendations for Prineo and Cosmetic Surgery Incisions
I recommend for cosmetic surgeons using Prineo in the future, to remove the mesh yourself. Not only will you feel better, but you will do a better job than the patient. In addition, it is impressive to remove the mesh-glue and see, for the first time, the underlying incision and how clean and tension-less it looks. Then, you can use a mirror and show it to your plastic surgery patient. They will likely be just as impressed.
Consistent Tension Reduction across Breast Lift with Prineo
Speaking to tension! I really appreciate the tension reduction I have seem in breast lift incisions, specially at the “T” junction of the anchor pattern breast lift. For me, the lower “T” junction has always been a challenge. This area develops the most tension during breast lift closure and the oxygen level in this, the most distal part of the breast flap, is the weakest. This combination adds up to about 40 to 50% of patients developing delays in wound healing. Prineo offers a significant advantage here. The mesh-glue combination reduces tension in this critical region.
Now, don’t confuse the situation. The plastic surgeon still has to do a reasonable job at developing a robust flap and closing the incision with the least tension possible. But, even under the best conditions, there is still quite a bit of tension with most anchor pattern breast lifts. I have now observed the Prineo give me better results in the T area on three consecutive patients and I am impressed.
The mesh-glue tape has not let me down so far with tummy tuck, lower body lift, and breast lifts. I am looking forward to continuing to see the progress my patients make over the next few months.
I want to take this opportunity to say, in case anyone is wondering, I have no financial interests in Ethicon, Inc. or Johnson & Johnson, Inc.
Follow-Up on Prineo.
11 year ago
by Dr. Aldo
in Body Plastic Surgery
Scottsdale – I covered Prineo a few weeks ago. I had the pleasure of being one of the first plastic surgeons in the Arizona to test out this new wound closure product on several plastic surgery patients.
This week I was able to use the product on a variety of plastic surgery operations. We applied the mesh tape and Dermabond® technique on breast lift and tummy tuck incisions. Additionally, I was able to see the early results on a lower bodylift patient from a few weeks ago.
Prineo mesh: applications for plastic surgery.
My observations about the processs were these: 1. Removing the mesh is easy, even without adhesive remover. Our plastic surgery patient was very comfortable during this step. 2. The wound was very smooth underneath the tape and was well protected. 3. The combination of mesh and glue, made a very hearty blanket of protection on top of the wound.
Easy removal, thick protective layer.
The bottom line so far, I’m impressed. The incision looked great under the water-resistant dressing provided by Prineo. In the photo above, it is easy to appreciate the thick wall of glue and mesh that allows for maximal barrier protection. I believe the incision looks great underneath because of the tension-reducing properties of the tape.
We plan to keep on updating the progress. We especially thank all our patients who were kind enough to allow for us to use these before and after plastic surgery photos. This is the kind of product that gives me extra confidence with the closure of circumferential wounds like you might see with lower bodylift and belt lipectomy.
Will the iPad change the way medicine is done?
11 year ago
by Dr. Aldo
in Medical Technology
Will the iPad change things?
Scottsdale – Apple, Inc., has a new tablet computer. It is called the iPad. Will this change the way medicine is done in America?
I am not sure, but I can honestly tell you, I have been waiting for an advanced tablet product for many years. It is possible that an efficient, light platform like the iPad could simplify my daily routine in clinic.
Here is where I think the Apple’s iPad can help me:
- Facilitate entry of medical record data while in the examination room with the patient.
- Schedule patient appointments in the examination room, without having patients return to the front desk.
- Check patients out when they make any purchases in-office, such as Botox injections, dermal fillers, and skin care.
- Access before and after photos for comparison and discussion with the patient about plastic surgery results.
- Allow for an improved patient experience by reducing their steps and wait time in our office.
These 4 changes in my daily routine will make the office run more efficiently. I am thinking about purchasing several Apple iPad tablets so that my nurse and medical assistant can help schedule patients and look up any important information without having to go back to their desks . At least this will save some leg work, if not a tremendous amount of time!
At the AB Guerra Plastic Surgery Center, our practice stays in the forefront of technology and health care by considering the latest advancements for plastic surgery in Scottsdale.
Wash before surgery and reduce infections.
02 years ago
by Dr. Aldo
in Body Plastic Surgery
A better approach against Staph
Scottsdale – A report in Medscape.com and originally published int he New England of Journal of Medicine, focuses attention on patients that are nasal carriers of Staphylococcus aureus and who are at increased risk for health care related infections.
“Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism,” write Lonneke G.M. Bode, MD, from Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues. “Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.”
The research was performed as a randomized, double-blind, placebo-controlled, multicenter trial and theorizes decolonization of nasal and extra-nasal sites on hospital admission may reduce the risk of post-operative infection. A total of 6771 patients were screened on admission. The research found, 1270 nasal swabs from 1251 patients were positive for Staph. They enrolled 917 of these patients in the intention-to-treat analysis and 808 (88.1%) underwent a surgical procedures.
The patients were divided into a treatment group, receiving mupirocin and chlorhexidine before surgery, and a placebo group, which received sham treatment.
The results of the study demonstrated a rate of Staph infection of 3.4% (17 of 504 patients) in the mupirocin and chlorhexidine group, as compared with 7.7% (32 of 413 patients) in the placebo group. The effect of mupirocin–chlorhexidine treatment was significant and most pronounced for deep surgical-site infections. The research concluded the number of surgical-site Staph infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of Staph on admission.
This is interesting research and I wonder if it can be applied to outpatient plastic surgery? I already recommend Hibiclens for preoperative showers for major body contouring surgery and I find that it helps to reduce the risks of infection. I believe that in the future, a study looking specifically at these medications in Arizona plastic surgery would be extremely useful.
Tiny computer chip may help detect breast and other cancers
02 years ago
Fight Breast Cancer.
Scottsdale – Canadian researchers have developed a tiny computer that may allow doctors to check a woman’s breast cancer risk. The investigators said the pocket sized device can use just droplets of blood or breast tissue to measure the levels of estrogen. These are far smaller samples than used with conventional methods which can quickly screen breast cancer risk (World News). The diagnosis can be made via less invasive methods and the manufacture of the device is less costly than other diagnostic methods. The chip is also being studied to diagnose other types of cancers.
The University of Toronto investigators said, “the new device is compatible with extremely small samples – around 1,ooo times smaller than the amount needed for conventional analysis”. Dr. Mousa of the University of Toronto, who also worked on the study said the device can also be used to check on the effectiveness of breast cancer drugs (Reuters).
While the device is experimental, it is estimated that the technology will be available within the next 5 years. Such a device could be come a “pocket” diagnostic tool that can be transported and utilized with greater ease. It is exciting to see the future development of such technology that can reduce and simplify the diagnosis of complicated medical conditions (model used in illustration).
Absorbable dermal staplers – success!
02 years ago
by Dr. Aldo
in In the news
Scottsdale – The absorbable INSORB dermal stapler is believed to be faster and more cost effective than sutures for dermal layer closures and provides a safer and more consistent result without compromising on the cosmetic results. This is the first study which supports this technique as a successful option for wound closure and is reported in the July issue of Plastic and Reconstructive Surgery Journal. Closure with dermal sutures is time consuming, is believed increase the risks of inflammation and infection secondary to foreign body reaction, and has variable cosmetic outcomes depending on each surgeon’s technique and skill.
The study was carried out as a prospective, randomized, controlled study. Patients undergoing bilateral breast reconstruction with tissue expanders had one incision randomized to dermal closure with absorbable dermal staples. The other side was closed with dermal sutures. During the expansion period, wounds were assessed by a blinded plastic surgeon using the 13-point Vancouver Scar Scale. Later, when the expander was removed and a permanent implant placed, both scars were excised and examined under the microscope for histologic signs of inflammation.
The results were excellent for the absorbable internal stapling device. Eleven patients (22 breast incisions) were enrolled in the study. The Insorb dermal stapler was four times faster than standard suture closure, reducing closure time by 10.5 minutes, a statistically significant difference between the two techniques. The cost savings with the dermal stapler was $220 per surgery. In the early postoperative period, the dermal stapler had a higher score versus the sutures because of superior wound eversion, a beneficial characteristic for wound healing. At 4 months after surgery, no significant difference in scar scores was found between interventions. At 6 months, histologic analysis suggested decreased inflammatory cell invasion of the dermal stapler-closed scar.
The researchers concluded that using the absorbable dermal stapler can be performed significantly faster than standard suture closure techniques, allowing for a more cost-effective incisional closure with equivalent cosmetic results. I have been using this dermal device for 2 years and I conclude that it helps to create excellent scarring and in many cases beautiful scars that fade quickly.
Pain Pumps reduce pain for breast augmentation patients – study shows
12 years ago
Scottsdale – Last month we highlighted an article about pain pumps in breast reconstruction. This month our focus is breast augmentation and pain pumps. The May 2208 issue of the Aesthetic Surgery Journal presented a large (644 patients) study about breast augmentation and pain pumps – the effectiveness and safety.
For the study, patients were given a choice of intermittent bolus or continuous flow catheters for pain control. Prior to discharge, a local anesthetic was instilled by a nurse into catheters for those patients receiving bolus self-administration. Patients then instilled 1 to 2 additional doses of the agent during the first 24 hours and recorded pain scores in the evening and the following morning. For patients using continuous flow catheters, the local anesthetic was used to fill pumps that allowed up to 2 days of continuous flow at a rate of 2 mL (about 1/2 a tablespoon) per hour per side. These patients recorded pain at time intervals similar to those of patients using bolus self-administration.
Questionnaires were given to all patients to determine the extent of pain reduction following the instillation of local anesthesia. More than 200 complete questionnaires were gathered, and pain scores from each of these were analyzed to gauge the efficacy of the instillation regimen.
Impressively, 88 percent of patients who self-administered medication reported pain reduction on the evening of surgery, and 78% reported a reduction the following morning. Catheters were maintained for 1 day post-surgery in 544 patients and for 2 days by 100 patients. One patient developed an infection of unknown etiology that ultimately resulted in the loss of a unilateral implant.
The take home lesson for me on this study is that paim pump catheters work and extremely well in reducing pain for breast augmentation patients. Importantly, the study was performed in a prospective style, which adds strength to the conclusions obtained by the authors. In summary, indwelling catheters for the postoperative instillation of bupivacaine are safe and effective in the management of postoperative pain. Patients benefit from an additional form of analgesia, limited to the operative site, which is effective. Both continuous flow and intermittent bolus self-administration systems are effective and their patient ratings are indistinguishable.
