Key recommendations support use of  opioid-sparing perioperative medications  , minimal preoperative fasting and early feeding , use of anesthetic techniques that decrease postoperative nausea and vomiting and pain , use of measures to prevent intraoperative hypothermia , and support of early mobilization after surgery .
Background : Enhanced recovery following surgery can be achieved through the introduction of evidence -based perioperative maneuvers .
This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery  and to provide evidence -based recommendations for an enhanced perioperative protocol .
A Comparison of a New Skin Closure Device and Intradermal Sutures in the Closure of Full-Thickness Surgical Incisions
Background : A novel topical skin adhesive system was developed to close the outermost layer of skin in an expeditious manner . To determine its clinical utility , a clinical investigation was undertaken to demonstrate equivalence of a new adhesive skin closure system ( Prineo Skin Closure System ) to intradermal sutures in wound closure . Methods : The investigation included 83 patients who underwent elective abdominoplasty , circumferential body lift procedures , and breast reconstruction with deep inferior epigastric perforator flaps . Incisions were divided in half , and each half was r and omized to wound closure with the new skin closure system , including a pressure-sensitive adhesive mesh tape for wound edge approximation and next-generation cyanoacrylate or intradermal sutures . Postoperative evaluations took place at 24 hours , 7 days , 12 to 25 days , 90 days , 6 months , and 12 months . Results : The new skin closure system was found to be equivalent to intradermal sutures for the continuous approximation of wounds . The upper limit of the two-sided 90 percent confidence interval for difference in proportions was 10.9 percent . The mean time to closure for the new skin closure system was 1.46 minutes , approximately 5 minutes faster than that for intradermal sutures ( p < 0.0001 ) . Both treatments had similar incision healing and cosmetic outcomes . No quantitative or qualitative differences of clinical significance were evident between the treatment groups . Conclusions : The Prineo Skin Closure System can be considered equivalent to intradermal sutures for full-thickness surgical incisions with regard to safety and effectiveness . The ease and speed of application contribute to shortened operative times ( 4.5 times faster than intradermal sutures ) . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , II
Key recommendations support use of  opioid-sparing perioperative medications  , minimal preoperative fasting and early feeding , use of anesthetic techniques that decrease postoperative nausea and vomiting and pain , use of measures to prevent intraoperative hypothermia , and support of early mobilization after surgery .
Background : Enhanced recovery following surgery can be achieved through the introduction of evidence -based perioperative maneuvers .
This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery  and to provide evidence -based recommendations for an enhanced perioperative protocol .