Article

The use of the Alexis® device in breast augmentation to improve outcomes: A comparative randomized case-control survey

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Abstract

Background: We present our experience in using a disposable wound retractor commonly used in abdominal surgery named Alexis(®) (Applied Medical Resources Corporation, Rancho Santa Margarita, CA, USA), during breast augmentation in order to improve outcomes, particularly final scar length. Methods: Between January 2010 and November 2012, 40 patients undergoing breast augmentation with an inframammary approach were enrolled in the present study. Patients were randomly assigned to two groups: group 1 underwent breast augmentation with the standard technique; group 2 underwent breast augmentation by using the Alexis(®) (Applied Medical Resources Corporation) device. Patients were followed-up for a 12-month period. The time of surgery, the days of drain duration and the length of the incisions were recorded for both groups and statistical significance was evaluated with the Wilcoxon rank sum test. Also, final scar appearance was evaluated using a visual analogue scale (VAS). Results: Patients in group 2 reported a lower incidence of hematomas and had shorter drain duration. The difference in scar length between the two groups was statistically significant (P<0.05). Surgeons and patients were mostly satisfied with the final appearance of the scar. Conclusions: The use of the Alexis(®) (Applied Medical Resources Corporation) device has proven useful in reducing the length of the inframammary incision. Interestingly, the increased visibility obtained with the use of the Alexis device allowed a better hemostasis, as suggested by the shorter drain duration and lower incidence of hematomas. However, its use prolongs the operative time, for which we recommend surgeons to allow themselves some time to become familiar with the device. Level of evidence: level I, evidence obtained from at least one properly designed randomized controlled trial.

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... In addition to reducing the rate of surgical site infections, they also facilitate the ability to perform complex surgical procedures through a smaller incision and are frequently used in open abdominal procedures. A recent study had also evaluated the ability of wound protectors in reducing the incision size and subsequent scar formation [4]. ...
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Of the various possible incisions for breast augmentation, the transareolar access has gained only limited popularity. The potential side effects of this incision are said to be altered nipple sensation, impaired lactation, an increased rate of infections with capsular fibrosis, well visible scar formation with hypopigmentation, and the need for an additional access in case a breast ptosis correction should prove necessary at a later date. The purpose of this retrospective study was to judge advantages and limitations of transareolar breast augmentation, and to verify whether the reluctant attitude toward this surgical approach is justified. A sample of 18 patients with a transareolar, retropectoral breast augmentation was selected for a retrospective evaluation. The suitability of the technique in general was examined together with early postoperative complications, sensory changes, and late complications on the basis of an evaluation system for cosmetic surgical results. The study showed that only women with an areolar diameter of 3.5 cm or more without pronounced breast ptosis were suitable for the transareolar access. No early infections were noted. The rate of capsular fibrosis was 11%. Two years after breast augmentation, 16 women (89%) judged their breast sensation to be normal, but objective assessment showed that mean pressure and vibration sensation were moderately compromised in all parts of the breast. The scars were of good quality, with very little hypopigmentation. With appropriate patient selection, respecting the advantages and limitations, the transareolar incision has its definite place among the different incisions for breast augmentation.
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We prospectively investigated whether the wound-protective Alexis (Applied Medical, Rancho Santa Margarita, CA) wound retractor was effective in preventing surgical site infection (SSI). We examined the actual condition of SSI in a 12-month randomized, controlled trial consisting of 221 patients who had undergone nontraumatic gastrointestinal surgery. The patients were divided into a With Alexis retractor group (n = 111) and a Without Alexis retractor group (n = 110). We also analyzed SSI separately on the basis of surgical sites such as gastric surgery or colorectal surgery. Overall estimation showed a significant decrease in wound infection (superficial incisional SSI) in the With Alexis retractor group. In the analysis based on surgical sites, a significant decrease in wound infection was noted in the With Alexis retractor group, the members of which had undergone colorectal surgery. There was no significant difference between the two groups in the occurrence of organ/space SSI, including anastomotic leak or intraperitoneal abscess. It was suggested that the use of the Alexis wound retractor would protect surgical wounds from contamination by bacteria and thus prevent infection.
Augmentation mammoplasty
  • J Hunt
  • J Salomon
Hunt J, Salomon J. Augmentation mammoplasty. Selected Read Plast Surg 2002;9:1-47