Plastic and Reconstructive Surgery • February 2016
to larger wounds and would be limited by other aspects
related to wound size such as contour; for example, a
dressing on a large wound spanning a joint may not
achieve an airtight seal and therefore will not be effec-
tively powered by the mechanical suction source.
We agree that as the wound fluid drains into a
mechanical drain–powered system, pressure deliv-
ery will slowly degrade, and the rate at which pressure
decreases is determined by the size and geometry of the
drain itself. In our clinical practice, we observe improved
wound appearance after application of negative pres-
sure even at 25 mmHg, the lowest setting programma-
ble on commercially available devices, and therefore
we are willing to tolerate some degree of pressure deg-
radation. For our study, we defined negative-pressure
delivery failure as falling below 75 percent of starting
pressure, which for our bellows correlated to an expan-
sion of the bellows ridges to 5 cm in length, providing an
objective means for nursing staff to monitor the system.
In addition, we required the dressing to remain intact
without fluid seepage or accumulation, which are other
clinical parameters used to monitor negative-pressure
wound therapy delivery. To answer the authors’ question
regarding frequency of changing the suction delivery/
fluid receptacle apparatus used in their setting, this will
be dependent on the minimum amount of suction they
wish to deliver to the wound surface and the correlation
between pressure and volume of the drain they choose
to use, which can be predetermined with a manometer.
Regarding patient movement, we would encourage
patients with dressed open wounds to be ambulatory and
to perform physical therapy, with monitoring to ensure
the dressing remains adhered and sealed to the peri-
wound skin after sessions. Those with skin grafts over
their wounds will need their movement to be restricted
to prevent shearing forces on the graft. The polymer
used to seal the dressing is waterproof and, if the dressing
remains adhered, should not allow exudate to seep out.
We do believe there are advantages to the rubber
bellows–shaped drain used in our study compared with
the bottle-shaped drain reported elsewhere. The rub-
ber bellows can be resterilized and reused. Once an ini-
tial calibration of pressure delivery at various degrees
of drain compression is performed of a bellows-shaped
drain by a manometer, the ridges provide a convenient
method for monitoring negative-pressure delivery visu-
ally in real time by the end-user, without additional
gauges needing to be installed.
DOI: 10.1097/01.prs.0000475806.22844.21
Gita N. Mody, M.D., M.P.H.
Division of Thoracic Surgery
Brigham and Women’s Hospital
75 Francis Street
Boston, Mass. 02115
gmody@partners.org
disclosure
The author has no financial interest to declare in relation
to the content of this communication.
484e
Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
So … Are You Failing the Marshmallow
Test? Connecting and Disconnecting in Our
Information-Rich World
Sir:
T
hank you, Dr. Rohrich, for your editorial on addic-
tion to smartphones.1 I joke to friends and cowork-
ers that the picture of a physician in a hospital is no
longer one with his or her head up and making eye
contact, but with head buried in a phone while navigat-
ing the hallways. I’m sure you’ve seen people crash into
walls and other people while texting and walking in the
hospital corridors.
I will, in particular, highlight your editorial with
our residents. I’m glad that a plastic surgeon of your
experience and stature has written this, so that resi-
dents realize it is perfectly fine to leave the phone in
the off position during an operation.
It might be interesting at one of the small group
sessions at an American Society of Plastic Surgeons’
meeting to randomly audit how often people check
their phone while in the audience of a keynote address
or panel presentation.
Thank you, again, for this editorial!
DOI: 10.1097/01.prs.0000475818.73530.39
Michael T. Friel, M.D.
Division of Plastic Surgery
University of Mississippi Medical Center
2500 N State Street, L-222
Jackson, Miss. 39216
mfriel@umc.edu
DISCLOSURE
The author has no financial interest to declare in relation
to the content of this communication.
reference
1. Rohrich RJ. So … are you failing the marshmallow test? Con-
necting and disconnecting in our information-rich world.
Plast Reconstr Surg. 2015;135:1751–1754.
Technology and Plastic Surgery: Potential
Pitfalls for Patient Confidentiality and
Proposed Solutions
Sir:
W e read with great interest the article by Patel et
al. entitled “Technology and Plastic Surgery:
Potential Pitfalls for Patient Confidentiality and Pro-
posed Solutions.”1 The authors are to be congratu-
lated for their interest in patient confidentiality and
the proposed solutions to secure protected health
information.
In our study of the use of photography conducted
with 176 plastic surgeons,2 the surgeons often shared
their photographs with others surgeons (71.1 per-
cent) and sometimes shared them with other medical
personnel (48.8 percent). A secure server was used