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Background Surgical site complications (SSCs) pose a major post-operative challenge. Single-use negative pressure wound therapy (sNPWT) systems have been shown to be effective for reducing SSCs. An upgraded sN-PWT system (PICOTM 7) with improved functional performance and ease-of-use was assessed in a prospective, single-arm study. The study aimed to assess if the system was a safe and effective therapy for delivering consistent negative pressure. Methods Between November 2018 and May 2019, eligible patients across 11 sites with a closed abdominal or knee arthroplasty incision, skin graft or flap, were enrolled. Postoperatively, patients received sNPWT for up to 7 days with follow-up until 30 days. Endpoints included the ability to maintain a consistent negative pressure for the intended duration, complication rates, clinician and patient usability and satisfaction and serious adverse events. Results The device was capable of delivering consistent negative pressure across all assessed surgical wounds and was statistically equivalent to the reference negative pressure (-80.2 mmHg) (n=46; p=0.002). Low complication rates were observed within 30 days post-surgery. High levels of clinician usability (>90%) and patient satisfaction (95%) were reported. No serious device-related adverse events were reported. Conclusions The study demonstrated the functional performance, favourable safety profile and clinician- and patient-reported satisfaction of this upgraded PICO 7 sN-PWT device across multiple closed surgical wound types. Implications Application of an sNPWT system can lead to improved wound healing outcomes within closed surgical wounds while also demonstrating high levels of clinician and patient satisfaction. [ABSTRACT FROM AUTHOR]

The profitability of medical treatment has gained increasing importance in health politics and likewise has become a considerable part of a microsurgeon's daily practice. The resulting cost pressure leads to microsurgeons having to justify their often complex and expensive treatments against hospital providers and health insurances. In this position paper of the German Speaking Group for Microsurgery of Peripheral Nerves and Vessels, we analyze the current status of profitability of microsurgical extremity and breast reconstruction, and its impact on choice of therapy and residency training. We specifically highlight the available literature, that shows often reduced long-term treatment costs after microsurgical reconstruction in comparison to cheaper initial treatments. The statements are based on a consensus workshop on the 40th meeting of the DAM in Lugano, Switzerland., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Secondary lymphedema is a complex and devastating disease including chronic inflammation and reduced immunofunction, lymphatic fluid and protein accumulation due to misdirected lymphatic transport, and secondary fat deposition followed by fibrosis. While the domain of treatment still is lifelong complex decongestive therapy, it is more and more widespread to treat the disease with a surgical focus on physiologic, reconstructive strategies or debulking surgery. Lymphovenous Anastomosis (LVA) and Vascularized lymph node transplantation (VLNT) are the mostly frequently applied, reconstructive techniques which address restoration or improvement of physiologic lymph clearance. The article summarizes and discusses the recommendations of an expert panel on the diagnostic, indication and therapy of LVA and VLNT in secondary lymphedema during the 40 th Meeting of the Germanspeaking Society of Microsurgery in Lugano, Switzerland, 2018. The expert panel addressed the basic diagnostics prior to lymphoreconstructive surgery, including the inevitable application of Indocyanine Green (ICG) based fluorescence lymphangiography and navigation for both techniques including reverse mapping to reduce the rate of donor-site lymphedema for VLNT as well as the use of lymphedema-specific quality of life questionnaires. Both LVA and VLNT are elaborately described, including tips and tricks on identifying functional lymphatic collectors, equipment, types of anastomosis and documentation for LVA and choice of donor and recipient site, number of includable lymph nodes and management of specific donor sites, e. g. jejunal mesenteric for VLNT. The synchronous and sequential application of LVA, VLNT and/or ablative liposuction is discussed against the background of the effectivity and morbidity of both reconstructive, physiologic techniques. Finally, recommendations on post-operative treatment and diagnostics are discussed. The present consensus paper intends to improve the level of standardization for further multicenter studies in the germanspeaking countries in this aspiring field of lymphedema treatment., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)