Phillips Brett T, Wang Eric D, Mirrer Joshua, Lanier Steven T, Khan Sami U, Dagum Alexander B, Bui Duc T
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
Ann Plast Surg. 2011 May;66(5):460-5. doi: 10.1097/SAP.0b013e31820c0593.
Despite their widespread use, there are no evidence-based guidelines on the management of closed-suction drains or antibiotics in postmastectomy breast reconstruction. The purpose of this study was to assess consensus and variation in postoperative care among plastic surgeons.
The authors designed and administered a self-reported, anonymous survey to 4669 American Society of Plastic Surgeons and Canadian Society of Plastic Surgeons members in October 2009.
A total of 650 completed surveys were available for analysis. A majority (>81%) of respondents reported using closed-suction drains in breast reconstruction. Most surgeons (>93%) used a volume criteria for drain removal, most commonly when drain output was ≤30 mL over 24 hours (>86%). Preoperative antibiotic use was nearly universal (98%), usually consisting of intravenous cefazolin (97%). Postoperative care demonstrated less uniformity with outpatient antibiotics administered by 72% of respondents. Surgeons were divided on when to discontinue outpatient antibiotics: 46% preferred concomitant discontinuation with drains, whereas 52% preferred a specific postoperative day. No clear consensus was observed for the number (1 or 2) or type (Jackson-Pratt or Blake) of drains used. Respondents were further divided on the restriction of postoperative showering with drains and the use of acellular dermal matrix.
These results demonstrate a consensus for drain use, drain removal, and preoperative antibiotic administration. There was no consensus for number or type of drain used, postoperative antibiotic use, shower restrictions, and use of acellular dermal matrix. Our results further emphasize the need for evidence-based postoperative-care guidelines specific to breast reconstruction.
尽管封闭式吸引引流管和抗生素在乳房切除术后乳房重建中广泛使用，但尚无基于证据的管理指南。本研究的目的是评估整形外科医生术后护理的共识和差异。
作者于2009年10月设计并向4669名美国整形外科协会和加拿大整形外科协会成员发放了一份自我报告的匿名调查问卷。
共有650份完整调查问卷可供分析。大多数（>81%）受访者报告在乳房重建中使用封闭式吸引引流管。大多数外科医生（>93%）采用引流量标准来拔除引流管，最常见的是当24小时引流量≤30 mL时（>86%）。术前使用抗生素几乎是普遍现象（98%），通常使用静脉注射头孢唑林（97%）。术后护理的一致性较差，72%的受访者给予门诊抗生素治疗。外科医生在何时停止门诊抗生素治疗方面存在分歧：46%的人倾向于与引流管同时停用，而52%的人倾向于在术后特定日期停用。对于引流管的数量（1根或2根）或类型（杰克逊-普拉特引流管或布雷克引流管）没有明确的共识。受访者在带引流管时术后淋浴的限制以及脱细胞真皮基质的使用方面也存在分歧。
这些结果表明在引流管使用、引流管拔除和术前抗生素给药方面存在共识。在引流管的数量或类型、术后抗生素使用、淋浴限制以及脱细胞真皮基质的使用方面没有共识。我们的结果进一步强调了针对乳房重建制定基于证据的术后护理指南的必要性。
