COOK Medical Biodesign Gebrauchsanweisung Seite 6

17. Place the cylinder so that it contacts the base of the donor site and has
good contact with the pedicle (blood supply). Wrap the flap around
the cylinder to provide complete contact between the cylinder and
vascularized tissue flap, leaving no gap between them. Suture the flap
into place using non-resorbing or slow resorbing suture, as shown in
Figure 4.
18. Fix the cylinder firmly to the skin flap using a slow resorbing suture.
a. To help maintain projection, place a suture through the top of the
cylinder and secure firmly to the flap cover to suspend the cylinder in
the silo, as shown in Figure 5.
b. Additionally, a horizontal suture can be placed in an "X" pattern through
the base of the cylinder and secured to the base of the silo.
19. Complete the surgical procedure by closing all incision sites with a non-
resorbing or slow resorbing leak tight suture line, as shown in Figure 6.
20. Discard any unused portions of the cylinder according to institutional
guidelines for medical waste.
21. Remove the sterile nipple shield components from the pouch and attach
the soft shield backing to the hard domed cover. Nipple shield should
be applied to dry skin. An absorbent pad should be applied between the
skin and the base of the shield to wick away moisture.
22. Position the shield around the reconstructed nipple such that the oval
cutout in the soft shield backing spans the donor site suture line.
NOTE: Consider wrapping the nipple with a non-adherent dressing to
prevent any direct contact between the shield and reconstructed nipple.
For any overlap of suture line and shield backing, consider using silicone
tape or appropriate dressing to prevent contact.
23. Anchor or support the nipple shield with a dressing that is skin
compatible and patient friendly.
POSTOPERATIVE CARE
• The nipple shield should be worn continuously for 6 weeks following
cylinder implantation, and then for an additional 3 weeks during periods
of sleep.
• Basic local wound care should be applied to the surgical site in the
immediate post-operative period.
• The patient should immediately report purulent drainage from the incision
line or exposure of the device.
• The patient should not trim or pull on scabs, exposed material, or exposed
strands of cylinder material.
• Nipple sutures should remain in place for at least 6 weeks. Donor site
sutures may be removed at approximately 10 days based upon visualized
tissue healing.
• Moisture should be avoided around the site for at least 7 days. An
absorbent pad should be worn under the shield to wick away moisture.
• The nipple shield should be cleaned and disinfected by the patient daily
for the entire duration of use. Remove the soft backing from the hard shell
and wipe all surfaces with 70% isopropyl alcohol or equivalent. Ensure the
shield is dry prior to use.
• The patient should wear loose or other non-compressive clothing for at
least 8 weeks following nipple reconstruction.
• NOTE: If the surgeon's preference is to create or use his or her own shield,
ensure that the shielding:
• Provides a firm but flexible area of protection around the reconstructed
nipple and is capable of keeping compressive loads away from the
nipple area.
• Does not compress peripheral blood supply.
Figure 4
Figure 5
Figure 6
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