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 .
Evaluation of a New Wound Closure Device for Linear Surgical Incisions: 3M Steri-Strip S Surgical Skin Closure versus Subcuticular Closure
Background : Technological innovations are often adopted before scientific comparison to an accepted st and ard . The authors ' study compared suture with a new coaptive film device , 3 M Steri-Strip S Surgical Skin Closure , on linear incisions . Methods : Patients undergoing Wise-pattern breast reduction or abdominal procedures had paired incisions r and omly assigned to Steri-Strip S or suture closure . Key outcome measures were closure time , patient comfort , and scar quality at 6 months by patients and surgeons using a new scar evaluation tool , visual assessment of linear scars . Statistical differences between the two closure techniques were assessed by Wilcoxon signed rank test . Results : Of 59 patients , eight were excluded from r and omization ( a surgeon judged Steri-Strip S to be a nonviable closure technique for mismatched wound edges ) . Fifty-one patients ( breast , n = 24 ; abdomen , n = 27 ) were r and omized .  Operative time with Steri-Strip S for breast was 2.0 minutes ( SD = 1.1 ) versus suture closure at 4.6 minutes ( SD = 1.5 ; p < 0.001 ) . Similarly , Steri-Strip S versus suture for the abdomen was faster ( p < 0.001 ; 4.9 minutes , SD = 2.3 versus 10.1 minutes , SD = 3.4 ) . Comfort scores did not differ between closures [ 5.8 ( SD = 2.7 ) versus 6.9 ( SD = 2.0 ) , respectively , on breast ( p = 0.142 ) and 7.7 ( SD = 1.8 ) versus 7.7 ( SD = 2.3 ) on abdomen ( p = 0.903 ) ] . Complication rates did not differ between closure types . Patients ' visual assessment of linear scars rating of breasts was 3.8 ( SD = 2.9 ) for Steri-Strip S and better at 2.6 ( SD = 2.9 ) for suture ( p = 0.008 ) . One surgeon rated breast Steri-Strip S scars worse than suture scars ( 4.3 versus 3.7 ; p = 0.014 ) . For abdominal scars , there was no difference in the patient or surgeon ratings . Conclusions : Steri-Strip S permits faster wound closure than suture . On the basis of patient reports of comfort and scar quality , surgeons increase efficiency and maintain quality with the use of Steri-Strip S on abdominal wounds but not on breast wounds
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 .