Plexaa: an innovation in preoperative preconditioning for breast cancer surgery patients to prevent wound healing complications and improve outcomes

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The NHS conducts \>10m operations p.a (Hospital\_Episodes\_statistics). From these, roughly 20% of patients suffer significant postoperative complications (Nepogodiev-2019; International\_Surgical\_Outcomes Study Group-2016). As well as being potentially avoidable, stressful events, these complications extend hospital stays, clog up NHS beds and push up treatment costs.The challenge and cost of managing postoperative complications to the NHS is predicted to increase by 10% p.a. as our population ages (Ludbrook-2019). Currently unhealed surgical wounds account for 11% (\>250,000 patients) of all wounds the NHS manages, with an attributable management cost of £982.9m p.a. (Guest\_2017). This creates a significanthealthcare need and commercial opportunity which is common globally.Plexaa has developed technology which delivers preconditioning therapy, where the surgical site is heated to a "supraphysiological" level, 43°C, 12-hours before surgery. This improves the blood flow to the skin this enhancing the patient's ability to heal and preventing wound healing complications. This is a non-invasive, pre-operative intervention that focusses on preventing surgical complications before they happen.Our previous NIHR-funded clinical research (preHEAT RCT-2019) proved this technique to be extremely effective at improving healing rates and preventing surgical wound complications. It also reduces the need for corrective surgery by 50%, outpatient visits by 70%, and hospital stays by 3-4 days per person -- all of which offer significant cost savings to the healthcare provider, estimated at £1,900-£2,300 per patient.While applicable to a very broad range of surgeries, we are targeting breast surgery as an initial specialisation. In part this is due to high surgical complication rates: ~30% of 102,000 p.a with 20% (\>20,000) needing reoperations. We can halve this number, improving physical, social and economic outcomes for patients, hospitals and the UK and offering potential savings of close to £100m per year.The proposed Plexaa device safely delivers the preconditioning in an accurate and consistent way suitable for home-use.The product represents our first device and will spearhead a new range of pre-conditioning products for surgery, tackling the twin social and economic issues of hospital occupancy and surgical wound complications.