Murray John D, Elwood Eric T, Jones Glyn E, Barrick Rebecca, Feng Jack
Division of Plastic Surgery, University of Illinois College of Medicine at Peoria;
Can J Plast Surg. 2009 Spring;17(1):17-21.
Risk factors for expander reconstruction infection are well known. However, drain use as a risk factor for the development of infection is unclear.
To review a simple method for drain use to help reduce rates of infection in expander breast reconstruction.
Two hundred consecutive single-surgeon (JDM) immediate first-stage expander breast reconstructions were retrospectively reviewed. The records were reviewed for history and physical examination, intra-operative technique, perioperative management, adjuvant therapy, and outcome with respect to expander infection necessitating premature explantation within the first eight weeks. Infection was defined on clinical basis, with or without culture positivity. All expanders (Mentor, USA) were the same model (textured, port-integrated and biodimensional). Two consecutive series of reconstructions were then created. The first series included 177 reconstructions while the second series included 23 reconstructions. Unlike the first series, the second series introduced a protocol in which all reconstructions received mupirocin 2% cream to the drain sites and all drains were removed at the end of the first week. Additionally, in the second series, all expanders were secluded from direct in vivo contact with the closed suction drain either by the use of an intervening Alloderm sling (LifeCell Corporation, USA, 15 of 23 breasts) or by subdermally tunnelling the drain superficial to an adequate fatty subcutaneous layer (eight of 23 breasts).
Patients who developed infection in the first series and all patients in the second series shared statistically the same level of aggregate risk factors (P=0.531). The infection rate (5.65%, 10 infections in 177 breasts) in the first series was statistically greater than in the second series (0%, 0 in 23 breasts, P=0.001).
The present study found that percutaneous closed suction drains do serve as an increased risk for expander infection. However, early results indicate that in vivo protection of the expander with Alloderm or subdermal tunnelling, topical antibiotic ointment use and early drain removal may significantly reduce expander infection.
扩张器重建感染的危险因素已为人熟知。然而，引流管的使用作为感染发生的一个危险因素尚不清楚。
回顾一种简单的引流管使用方法，以帮助降低扩张器乳房重建的感染率。
回顾性分析连续200例由同一位外科医生（JDM）进行的一期即刻扩张器乳房重建手术。查阅病历，了解病史、体格检查、术中技术、围手术期管理、辅助治疗以及因扩张器感染而在前8周内需要提前取出扩张器的情况。感染根据临床情况定义，无论培养结果是否为阳性。所有扩张器（美国曼托公司生产）均为同一型号（带纹理、集成端口且具有生物维度）。然后创建了两个连续的系列重建病例。第一个系列包括177例重建手术，第二个系列包括23例重建手术。与第一个系列不同，第二个系列引入了一项方案，即所有重建手术均在引流部位涂抹2%莫匹罗星软膏，且所有引流管在第一周结束时拔除。此外，在第二个系列中，通过使用中间的同种异体真皮吊带（美国LifeCell公司生产，23例乳房中有15例）或在足够厚的皮下脂肪层表面皮下隧道式放置引流管（23例乳房中有8例），使所有扩张器避免与闭式负压引流管直接体内接触。
第一个系列中发生感染的患者与第二个系列中的所有患者在总体危险因素水平上在统计学上无差异（P = 0.531）。第一个系列的感染率（5.65%，177例乳房中有10例感染）在统计学上高于第二个系列（0%，23例乳房中无感染，P = 0.001）。
本研究发现经皮闭式负压引流管确实会增加扩张器感染的风险。然而，早期结果表明，使用同种异体真皮或皮下隧道式放置引流管对扩张器进行体内保护、局部使用抗生素软膏以及早期拔除引流管可能会显著降低扩张器感染率。
