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Trial registered on ANZCTR
Registration number
ACTRN12612001197820
Ethics application status
Approved
Date submitted
13/11/2012
Date registered
14/11/2012
Date last updated
15/11/2012
Type of registration
Retrospectively registered
Titles & IDs
Public title
The application of heat to the breast before mastectomy and breast reconstruction to reduce wound healing problems.
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Scientific title
Prevention of tissue necrosis in skin-sparing mastectomy using localised pre-conditioning heat therapy: a prospective pilot study
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Secondary ID [1]
281531
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Skin necrosis
287795
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Breast reconstruction
287796
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Condition category
Condition code
Surgery
288147
288147
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0
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Other surgery
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Applying heat to the breast preoperatively using a hot-water bottle at 43 degrees centigrade. Patients were asked to heat-precondition their breast 24-hours prior to surgery using a hot water bottle with a water temperature of 43 degrees Celsius (thermometers provided), in three 30-minute cycles separated by 10 minutes of spontaneous cooling to room temperature.
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Intervention code [1]
286046
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Prevention
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Comparator / control treatment
Patients who have not undergone heat preconditioning. These patients were indentified from our local database of patients that underwent immediate breast reconstruction between 2007-2009.
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Control group
Historical
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Outcomes
Primary outcome [1]
288352
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Record the incidence of skin necrosis following skin sparing mastectomy that requires surgical treatment in all patients within 10 days of surgery. This is assessed by nurses and doctors on the wards who look after the patients postoperatively. There is no specific test as we check the wounds everyday for any signs of wound complications.
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Assessment method [1]
288352
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Timepoint [1]
288352
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From surgery up to 10 days post-operatively.
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Secondary outcome [1]
299934
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Measure change in vascularity due to heat preconditiong using laser-doppler imaging.
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Assessment method [1]
299934
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Timepoint [1]
299934
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Immediately preoperatively and after heat preconditioning
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Secondary outcome [2]
299935
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Record length of hospital stay
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Assessment method [2]
299935
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Timepoint [2]
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0 to 10 days
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Eligibility
Key inclusion criteria
BMI above 26
Sternal-notch to nipple distance above 26 cm
Breast cup size larger than C-cup
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Minimum age
18
Years
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Maximum age
70
Years
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Below 18 years of age
Smokers
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
16/07/2009
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
25
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
4678
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United Kingdom
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State/province [1]
4678
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Funding & Sponsors
Funding source category [1]
286314
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Hospital
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Name [1]
286314
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Guy's and St. Thomas' NHS Foundation Trust
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Address [1]
286314
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Westminster Bridge Road
London
SE1 7EH
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Country [1]
286314
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United Kingdom
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Primary sponsor type
Hospital
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Name
Guy's and St. Thomas' NHS Foundation Trust
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Address
Westminster Bridge Road
London
SE1 7EH
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Country
United Kingdom
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Secondary sponsor category [1]
285101
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None
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Name [1]
285101
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Address [1]
285101
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Country [1]
285101
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
288385
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Guy's and St. Thomas' NHS Foundation Trust Ethics Committee
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Ethics committee address [1]
288385
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3rd Floor Conybeare House Guy's Hospital St. THomas' Street London SE1 9RT
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Ethics committee country [1]
288385
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United Kingdom
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Date submitted for ethics approval [1]
288385
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22/03/2009
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Approval date [1]
288385
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16/07/2009
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Ethics approval number [1]
288385
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09/H0804/035
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Summary
Brief summary
Background: experimental data has shown a reduction of flap necrosis after local heat application to a supraphysiological level resulting from the up-regulation of heat-shock proteins, such as HSP-32 & 70. The proteins maintained capillary perfusion and increased tissue tolerance to ischemia. The purpose of this translational study was to evaluate the effect of local heat pre-conditioning before skin-sparing mastectomy and immediate breast reconstruction. Methods: a prospective non-randomised trial was performed from July 2009 – April 2010. 50 consecutive patients at risk of skin flap necrosis (BMI >30, sternal-to-nipple distance >26cm or breast size >C-cup) were included in the study. Twenty-five patients were asked to heat-precondition their breast 24-hours prior to surgery using a hot water bottle with a water temperature of 43 degrees centigrade (thermometers provided), in three 30-minute cycles interrupted by spontaneous cooling to room temperature. Skin flap necrosis was defined by the need for surgical debridement. LDI images were taken preoperatively to demonstrate an increase in tissue vascularity. Results: 36% of women (n=25) without local heat-treatment experienced skin flap necrosis, 12% developed skin flap necrosis in the treatment group, (n=23; p = 0.047 (95% CI 1% to 47%)). LDI scanning of the heated breast demonstrated an increase in vascularity compared to the contralateral non-heated breast. Median length of inpatient stay for treatment group was 4 days, controls 8 days (p = <0.001). Conclusions: the data suggests that in selected cases, local heat-preconditioning is a simple, non-invasive, and cost-effective method of reducing skin necrosis and length of hospital stay following skin-sparing mastectomy.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
34944
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Address
34944
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Country
34944
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Phone
34944
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Fax
34944
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Email
34944
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Contact person for public queries
Name
18191
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Saahil Mehta
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Address
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Guy's and St. Thomas' NHS Foundation Trust
Westminster Bridge Road
London
SE1 7EH
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Country
18191
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United Kingdom
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Phone
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+442071887188
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Fax
18191
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Email
18191
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[email protected]
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Contact person for scientific queries
Name
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Saahil Mehta
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Address
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Guy's and St. Thomas' NHS Foundation Trust
Westminster Bridge Road
London
SE1 7EH
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Country
9119
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United Kingdom
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Phone
9119
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+442071887188
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Fax
9119
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Email
9119
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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