Treatment of infantile haemangiomas before and after the introduction of propranolol: A retrospective study

Abstracts augmentation, 225 reconstruction, and 68 revision-reconstruction. Annual clinic visits collected complications, reoperations, explantations, and subject satisfaction; one-third of subjects underwent biennial MRI rupture screening. Kaplan-Meier risk rates were calculated for all local complications, reoperations, and explantations. Results: Capsular contracture rates increased w1%/year from the previously reported 6-year rates to the final 10-year by-subject rates of 9.2% for augmentation, 11.9% for revision-augmentation, 14.5% for reconstruction, and 26.8% for revision-reconstruction (by-implant rates of 6.9%, 7.8%, 10.3%, 20.5%). These rates are significantly lower than those from the Natrelleâ round gel core study (51% lower for augmentation and 59% lower for revisionaugmentation). The overall rupture rate in the MRI cohort for all indications was 16.4% for subjects and 9.7% for implants. Eleven late seromas (0.6% of study devices), and 1 occurrence of implantassociated ALCL were reported. For both augmentation and reconstruction subjects the most common reason for explantation was subject request for size/style change. Satisfaction rates remained high through 10 years, with the percentage of subjects saying they were somewhat or definitely satisfied with their implants at 96.2% for augmentation, 87.5% for revision-augmentation, 93.3% for reconstruction, and 90.0% for revisionreconstruction. Conclusion: Natrelleâ 410 anatomical form stable implants have demonstrated long-term safety and effectiveness, with low complication rates and high satisfaction rates.

THE DRAIN GAME: ABDOMINAL DRAINS FOR DEEP INFERIOR EPIGASTRIC PERFORATOR BREAST RECONSTRUCTION Ben H. Miranda, Kavit Amin, Jagdeep S. Chana Royal Free London NHS Foundation Trust, United Kingdom Introduction and aims: We recently published data for the duration of donor site drain back use in latissimus dorsi (LD) flap breast reconstruction; this evidence is still lacking for deep inferior epigastric perforator (DIEP) reconstruction. We compare inpatient hospital stay, drainage parameters and donor-site complications associated with closed suction abdominal drain removal by postoperative day (POD) 3 regardless of output (early group), with removal after POD 3 (late group), in post-mastectomy DIEP reconstruction donor sites. Material and methods: A retrospective review of DIEP breast reconstructions was undertaken between January 2011 and July 2012 to facilitate 1 year minimum follow-up per patient. Results: 78 patients underwent DIEP breast reconstructions; 74 records contained complete documentation. There were 41 patients in the late, and 33 in the early removal group; both were matched for age and number of donor site drains (2 per patient). Mean drain removal day (4.32  0.10dayse2.87  0.06days, p < 0.0001), total drainage (518.90  41.53 mlse283.79  18.06 mls; p < 0.0001) and hospital inpatient stay were greater for patients in the late versus early group. There were no differences in total complications (21.95% (9/41)e 12.12% (5/33); p Z 0.46), seroma (4.88% (2/41)e0% (0/33); p Z 0.20), dehiscence (4.88% (2/41)e9.09% (3/33); p Z 0.47) or haematoma (7.32% (3/41)e3.0% (1/33); p Z 0.42) rates between the late and early removal groups. Conclusion(s): These data suggest significant advantages for patients who have abdominal drains removed early by POD 3,

1607 without increased post-operative complications including seroma rates; these data are in keeping with our LD data. We recommend drain removal and patient discharge by POD 3.

TREATMENT OF INFANTILE HAEMANGIOMAS BEFORE AND AFTER THE INTRODUCTION OF PROPRANOLOL: A RETROSPECTIVE STUDY Jes C. Rødgaard a, Thomas Foged b, Jesper V. Bjerre a, Tine E. Damsgaard a a b

Aarhus University Hospital, Denmark Odense University Hospital, Denmark

Introduction and aims: In November 2008 the first patient with a hemangioma was treated with propranolol at The Center for Vascular Anomalies, Aarhus University Hospital. The aim of this study was to compare the treatment modalities (surgery, laser therapy and systemic medication) applied before and after the actual date. Material and methods: We retrospectively reviewed all patients treated for hemangioma between 1995 and 2012 at the University Hospital of Aarhus, Denmark. Outcome measures of interest included age at referral, the extent of evaluation by different specialities and the treatments administered. Results: 121 patients were included in the study. The patients were divided into two groups, patients treated before (study period 1) and after (study period 2) November 2008, respectively. In study period 2 patients were referred earlier for evaluation (0.82e1.91 years, p Z 0.011). Fewer patients were seen by plastic surgeons in study period 2 (63.9e98.8 percent, p < 0.001), with more patients being referred for systemic treatment (12.9e86.1 percent, p < 0.001). No difference in the number of patients evaluated by dermatologists was detected (p Z 0.417). In study period 2 fewer patients were treated with surgery (38.9e92.2, p < 0.001) and laser therapy (13.9e42.4, p Z 0.003). After November 2008 more patients have been treated with systemic pharmacotherapy (4.7e80.6 percent, p < 0.001). Conclusion(s): The introduction of propranolol has resulted in a decline in surgery and laser therapy at our institution. More patients are being referred for systemic pharmacotherapy, due to the treatment protocol of propranolol.

POSTERIOR CRANIAL VAULT DISTRACTION IN THE MANAGEMENT OF SYNDROMIC MULTI-SUTURE CRANIOSYNOSTOSIS: OUTCOMES AND 3D PHOTOGRAPHIC/CT-BASED MORPHOMETRIC ANALYSIS Christopher Forrest The Hospital for Sick Children, Canada Introduction and aims: Posterior cranial vault distraction has been popularized as a first intervention technique in the management of syndromic multi-suture craniosynostosis. The purpose of this study was to present our experience with posterior cranial vault distraction in the management of these complex patients.