Adams William P, Rios Jose L, Smith Sharon J
Department of Plastic Surgery, Parkland Health and Hospital System, Dallas, Texas, USA.
Plast Reconstr Surg. 2006 Jan;117(1):30-6.
Capsular contracture remains one of the most commonly reported complications in aesthetic and reconstructive breast patients. Previous in vitro studies from the authors' laboratory have recommended a new triple antibiotic povidone-iodine irrigation (2000) and subsequently a triple antibiotic non-povidone-iodine-containing irrigant (2001) to optimize broad-spectrum coverage of various bacteria implicated in capsular contracture; however, the clinical efficacy of these in vitro studies remains unproven. The purpose of this study was to determine the clinical efficacy for the previously reported triple antibiotic breast irrigation. The cost-effectiveness of universal application of irrigation solutions in breast prosthesis surgery was analyzed as well.
Patients undergoing aesthetic and reconstructive breast implant procedures were treated with a standardized operative technique, including the use of triple antibiotic breast irrigation by a single surgeon. Capsular contracture was assessed using a simplified Baker scale and graded by two independent caregivers to maximize objectivity and consistency. Additional complications were also recorded, including reoperation. Patient charges for antibiotic irrigation and reoperation for contracture were determined and compared.
A total of 335 patients operated on since 1997 were evaluated prospectively. They ranged in age from 18 to 86 years, and the mean follow-up was 14 months (range, 6 to 75 months). The rate of grade III/IV capsular contracture in the study groups was 1.8 percent for patients undergoing primary breast augmentation. Patients undergoing augmentation-mastopexy had a grade III/IV contracture rate of 0 percent. Breast reconstruction patients had a 9.5 percent rate of grade III/IV contracture.
Triple antibiotic breast irrigation is clinically associated with a low incidence of capsular contracture compared with other published reports, and its clinical efficacy supports previously published in vitro studies. Application of triple antibiotic irrigation is recommended for all aesthetic and reconstructive breast procedures and is cost effective.
包膜挛缩仍然是美容和乳房重建患者中最常报告的并发症之一。作者实验室先前的体外研究推荐了一种新的三联抗生素聚维酮碘冲洗液（2000年），随后又推荐了一种不含聚维酮碘的三联抗生素冲洗液（2001年），以优化对包膜挛缩中涉及的各种细菌的广谱覆盖；然而，这些体外研究的临床疗效仍未得到证实。本研究的目的是确定先前报道的三联抗生素乳房冲洗的临床疗效。还分析了在乳房假体手术中普遍应用冲洗液的成本效益。
接受美容和乳房重建植入手术的患者采用标准化手术技术治疗，包括由一名外科医生使用三联抗生素乳房冲洗。使用简化的贝克量表评估包膜挛缩，并由两名独立的护理人员进行分级，以最大限度地提高客观性和一致性。还记录了其他并发症，包括再次手术。确定并比较了患者抗生素冲洗和挛缩再次手术的费用。
对自1997年以来接受手术的335例患者进行了前瞻性评估。他们的年龄在18至86岁之间，平均随访时间为14个月（范围为6至75个月）。在初次隆乳患者中，研究组III/IV级包膜挛缩的发生率为1.8%。接受隆乳-乳房固定术的患者III/IV级挛缩率为0%。乳房重建患者的III/IV级挛缩率为9.5%。
与其他已发表的报告相比，三联抗生素乳房冲洗在临床上与包膜挛缩的低发生率相关，其临床疗效支持先前发表的体外研究。建议在所有美容和乳房重建手术中应用三联抗生素冲洗，且具有成本效益。
