Local heat preconditioning to prevent wound breakdown and skin - - PowerPoint PPT Presentation

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Local heat preconditioning to prevent wound breakdown and skin - - PowerPoint PPT Presentation

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Local heat preconditioning to prevent wound breakdown and skin necrosis: A translational study Department for Plastc Surgery and Handsurgery Laboratory for Microcirculation and Regenerative Medicine Klinikum rechts der Isar Technische

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Department for Plastc Surgery and Handsurgery Laboratory for Microcirculation and Regenerative Medicine Klinikum rechts der Isar Technische Universität München Ismaninger Strasse 22 D-81675 Munich, Germany

Local heat preconditioning to prevent wound breakdown and skin necrosis: A translational study

  • D. Schmauß, T. Finck, S. Mehta, J. Farhadi, T. Egana, H.-G. Machens, Y. Harder

101st Annual Meeting of the Swiss Surgical Society 21st – 23rd May 2014, Kursaal Bern

Daniel.Schmauss@mri.tum.de

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  • 10. November 2015

Technische Universität München

Disclosures

2 Local heat preconditioning & breast surgery

  • Y. Harder is consultant for Hilotherm GmbH

Department of Plastic Surgery and Handsurgery

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  • 10. November 2015

Technische Universität München

The clinical problem

3 Local heat preconditioning & breast surgery

Ischaemically challenged tissue

Wound breakdown: up to 39% 1 Skin flap necrosis: up to 54% 2

[ 1 Zoumaras J et al.: Aesthet Surg J. 2008 ] [ 2 Sotheran WJ et al.: Ann R Coll Surg Engl. 2004 ]

Department of Plastic Surgery and Handsurgery

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[ Reinisch JF: Plast Reconstr Surg, 1974 ]

day 0 ~ day 7 ~ day 14 pO2 10 November 2015 4 Local heat preconditioning & breast surgery

Technische Universität München

Surgical delay

Department of Plastic Surgery and Handsurgery

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day 0 ~ day 7 ~ day 14 pO2 10 November 2015 5 Local heat preconditioning & breast surgery

Technische Universität München

Invasive and time-consuming

[ Reinisch JF: Plast Reconstr Surg, 1974 ]

Surgical delay

Department of Plastic Surgery and Handsurgery

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  • 10. November 2015

Technische Universität München

6 Local heat preconditioning & breast surgery

Application of supraphysiologic stress to tissue prior to surgery

  • Maintenance of microcirculation
  • Increase of ischaemic tolerance of the tissue

Tissue preconditioning as alternative

Department of Plastic Surgery and Handsurgery

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  • “True” preconditioning (PC)
  • Ischaemic

[ Murry CE et al: Circ Res, 1990 ]

  • “Remote” ischemic

[ Przyklenk K et al: Circulation, 1993 ]

  • Systemic pharmacological PC
  • Monophosphoryl Lipid A

[ Harder Y et al.: Anesth & Analg, 2005 ]

  • Erythropoietin

[ Harder Y et al: Surgery, 2009 ]

  • Ghrelin

[ Rezaeian F & Harder Y et al: Am J Physiol, 2012 ]

  • Local physical PC
  • Shock-wave

[ Tobalem M & Harder Y et al: J Surg Res, 2013 ]

  • Cooling

[ Yunoki M et al: J Neurosurg, 2002 ]

  • Heat

[ Yamashita N et al: Circulation, 1998;

Harder Y et al: Ann Surg, 2005]

10 November 2015 7 Local heat preconditioning & breast surgery

Technische Universität München

Tissue preconditioning as alternative

Department of Plastic Surgery and Handsurgery

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  • 10. November 2015

Technische Universität München

8 Local heat preconditioning & breast surgery

Effectiveness of repetitive local heat preconditioning

Incidence of

  • Wound break down
  • Skin flap necrosis

Study aim

Department of Plastic Surgery and Handsurgery

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  • 10. November 2015

Technische Universität München

9 Local heat preconditioning & breast surgery

1. Skin Sparing Mastectomy and immediate breast reconstruction

  • 25 patients:

Local heat preconditioning

  • 25 patients:

No preconditioning (control)

  • 2. Reduction Mammaplasty (RMP)
  • 15 patients:

Local heat preconditioning of one breast No preconditioning of the other breast (control)

Methods

Department of Plastic Surgery and Handsurgery

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10 November 2015 10 Local heat preconditioning & breast surgery

Technische Universität München

Methods

[ Hilotherm GmbH, Deutschland ]

Department of Plastic Surgery and Handsurgery

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  • 10. November 2015

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Technische Universität München

43°C 43°C 43°C

30’ 30’ 30’ 30’ 30’

PC initiated 18 hours prior to surgery

14 days

Mastectomy / Breast reduction Skin flap necrosis? Wound breakdown? Perfusion measurements

Local heat preconditioning & breast surgery

Methods

Department of Plastic Surgery and Handsurgery

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  • 10. November 2015

Technische Universität München

12 Local heat preconditioning & breast surgery

  • No burns were noticed
  • Heat-induced hyperaemia completely vanished

prior to surgery

  • Results. Overall

Department of Plastic Surgery and Handsurgery

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  • 10. November 2015

13

Technische Universität München

1 hour after mastectomy preconditioned

Right breast Left breast

Skin perfusion

1 hour after mastectomy un-preconditioned

Local heat preconditioning & breast surgery

Results: Skin Sparing Mastectomy

[ Farhadi J & Harder Y et al: J Plast Reconstr Aesthet Surg, 2013 ]

Department of Plastic Surgery and Handsurgery

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Mean *p < 0.05 vs. control

[ % ]

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Technische Universität München

Local heat preconditioning & breast surgery

*

Results: Skin Sparing Mastectomy

Skin flap necrosis

[ Farhadi J & Harder Y et al: J Plast Reconstr Aesthet Surg, 2013 ]

Department of Plastic Surgery and Handsurgery

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Mean±SD *p < 0.05 vs. control 10 November 2015 15

Technische Universität München

Local heat preconditioning & breast surgery

*

[ Farhadi J & Harder Y et al: J Plast Reconstr Aesthet Surg, 2013 ]

Length of hospital stay

Results: Skin Sparing Mastectomy

Department of Plastic Surgery and Handsurgery

[ Days ]

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  • 10. November 2015

Technische Universität München

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Wound breakdown

Results: Reduction Mammaplasty

Department of Plastic Surgery and Handsurgery

[ % ]

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  • 10. November 2015

Technische Universität München

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Wound drainage

Results: Reduction Mammaplasty

Department of Plastic Surgery and Handsurgery

[ ml/24hrs ]

Mean±SD

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  • 10. November 2015

Technische Universität München

18 Local heat preconditioning & breast surgery

Local heat preconditioning

  • Can be translated into daily clinical surgery
  • Increases perfusion in ischaemically challenged tissue
  • Significantly decreases skin flap necrosis
  • Reduces wound breakdown
  • Reduces length of hospital stay
  • Does not increase postoperative drainage

Summary

Department of Plastic Surgery and Handsurgery

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  • 10. November 2015

Technische Universität München

19 Local heat preconditioning & breast surgery

Local heat preconditioning in specific breast procedures

  • Safe
  • Simple
  • Efficient
  • Applicable briefly prior to surgery
  • Cost-effective

Conclusions

Department of Plastic Surgery and Handsurgery

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10 November 2015 20 Local heat preconditioning & breast surgery

Technische Universität München

LOCAL HEAT!!!

Department of Plastic Surgery and Handsurgery

Perspectives