Keefe Morgan S, Keefe Michael A
Science Division, Our Lady of Peace Academy, San Diego, California, USA.
Arch Facial Plast Surg. 2009 Jul-Aug;11(4):246-51. doi: 10.1001/archfacial.2009.45.
Reconstruction in the head and neck can be difficult owing to the size of the defect or characteristics of the tissue that needs to be replaced. Facial wounds or reconstruction sites can be subject to contamination, thereby risking infection of any implanted material even under ideal circumstances. Particular areas of concern are sites where minimizing the bacterial contamination prior to placing an implant is difficult (eg, the oral cavity and internal nose). Reconstruction involves the facial subcutaneous soft tissue and/or bone, and the ideal implant provides support and natural feel, as well as a low risk of infection. The biocompatibility of alloplastic implants depends on the tissue inertness of the implant and the porosity, allowing connective tissue ingrowth, which in turn decreases the susceptibility to infection. Scalafani et al demonstrated that alloplastic implants contaminated prior to fibrovascular ingrowth had a much higher incidence of infection and rejection.
To examine the effectiveness of several techniques for infiltrating antibiotics into alloplastic implants of different porosity using 2 commonly used alloplastic implants, expanded polytetrafluoroethylene (e-PTFE, or GORE-TEX) and porous high-density polyethylene (Medpor).
Using an in vitro bacterial growth inhibition model, we found that suction infiltration of the implant with antibiotics was the most effective technique, with a statistically significant advantage over other techniques used. The advantages of the suction impregnation were seen to be most effective using alloplasts with a smaller pore size (20-30 microm) (P < .001), but there was a statistically significant difference even with implants with a larger pore size (150-200 microm) (P < .001).
Suction infiltration of antibiotics into porous implants seems to be the most effective method identified using an in vitro testing protocol. Further experiments will be needed to confirm the effectiveness in reducing the perioperative risk of infection in vivo.
由于缺损的大小或需要置换的组织的特性，头颈部的重建可能会很困难。面部伤口或重建部位可能会受到污染，因此即使在理想情况下，任何植入材料都有感染的风险。特别值得关注的部位是在植入前难以将细菌污染降至最低的部位（例如口腔和鼻腔内部）。重建涉及面部皮下软组织和/或骨骼，理想的植入物应提供支撑和自然的感觉，同时感染风险较低。异体植入物的生物相容性取决于植入物的组织惰性和孔隙率，允许结缔组织向内生长，从而降低感染的易感性。Scalafani等人证明，在纤维血管向内生长之前被污染的异体植入物感染和排斥的发生率要高得多。
使用两种常用的异体植入物，即膨体聚四氟乙烯（e-PTFE，或戈尔特斯）和多孔高密度聚乙烯（Medpor），研究几种将抗生素渗入不同孔隙率的异体植入物的技术的有效性。
使用体外细菌生长抑制模型，我们发现用抗生素对植入物进行抽吸浸润是最有效的技术，与其他使用的技术相比具有统计学上的显著优势。在使用孔径较小（20 - 30微米）的异体材料时，抽吸浸渍的优势最为明显（P <.001），但即使是孔径较大（150 - 200微米）的植入物，也存在统计学上的显著差异（P <.001）。
使用体外测试方案确定，将抗生素抽吸浸润到多孔植入物中似乎是最有效的方法。需要进一步的实验来证实其在降低体内围手术期感染风险方面的有效性。
