eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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SCImago Journal & Country Rank
6/2020
vol. 37
 
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abstract:
Letter to the Editor

Clinical outcomes of hyperbaric oxygen therapy in treatment of postoperative chronic Pseudomonas aeruginosa wound infection following implant reconstruction of the breast

Tomasz Nowikiewicz
1, 2
,
Maria Szymankiewicz
3
,
Barbara Zegarska
4
,
Marta Biedka
5
,
Beata Nakonowska
3
,
Magdalena Nowikiewicz
6
,
Wojciech Zegarski
1

1.
Chair and Department of Surgical Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
2.
Department of Clinical Breast Cancer and Reconstructive Surgery, Prof. Franciszek Łukaszczyk Oncology Center, Bydgoszcz, Poland
3.
Department of Microbiology, Prof. Franciszek Łukaszczyk Oncology Center, Bydgoszcz, Poland
4.
Department of Cosmetology and Esthetic Dermatology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
5.
Chair and Department of Oncology and Brachytherapy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
6.
Student Scientific Society, Chair and Department of Surgical Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
Adv Dermatol Allergol 2020; XXXVII (6): 1009–1011
Online publish date: 2019/10/15
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Infection is one of the most common causes of failure of generative treatment for breast cancer patients who have undergone mastectomy. Surgical site infection (SSI) in patients requiring the use of a synthetic breast implant can currently be observed in about 1–53% of cases [1, 2].
The most often isolated bacterial strains responsible for the occurrence of SSI are saprophytic Gram-positive bacteria (49–67%) [1, 3–6]. Pathogens belonging to opportunistic in-hospital flora are Gram-negative rods or fungal wound infections, which may lead to complications [1, 4, 7]. SSI caused by these is characterized by a more severe course and a longer period of necessary treatment.
This paper describes the case of a patient who underwent a mastectomy with simultaneous breast reconstruction using the final prosthesis, which was complicated by the occurrence of SSI due to infection of the wound by a strain of Pseudomonas aeruginosa.
A 49-year-old patient was admitted to hospital in October 2017 for the surgical treatment of lesions in both breasts with atypical ductal hyperplasia (diagnosed via core needle biopsy) – a benign proliferative breast disease with a high frequency of coexisting cancer [8]. The woman had breast-conserving treatment (BCT) in June 2015 for left ductal carcinoma in situ (DCIS), with postoperative complementary 3D radiotherapy.
Histopathologic examination following quadrantectomy of both breasts revealed bilateral multifocal DCIS (with positive surgical margin). The patient was diagnosed with local recurrence in the left breast. The healing process of both wounds was free of complications.
The patient was referred to bilateral mastectomy with a sentinel node biopsy and simultaneous breast reconstruction (prosthesis Polytech, 445 ml).
On 6 December 2017, a left-sided skin and nipple-sparing mastectomy was performed with routine prophylaxis of antibiotic therapy (2.0 γ cefazolin injection for 5 days).
Complications arose with the appearance of ischaemic symptoms on the third day after surgery, followed by marginal necrosis in the lateral lobe (Figure 1 A). In addition to on-going antibiotic prophylaxis, the patient received pentoxifylline. On the fifth day local stability was achieved with partially demarcated necrotic tissues. After 2 weeks the patient was discharged to continue the healing process in an outpatient setting.
Subsequent check-ups revealed gradual...


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