Division of Plastic and Reconstructive Surgery, Emory University, 1364 Clifton Road NE, Atlanta, GA 30322, USA.
Aesthet Surg J. 2012 Feb;32(2):194-9. doi: 10.1177/1090820X11434505. Epub 2012 Jan 18.
BACKGROUND: Overt infection and biofilm formation resulting from breast augmentation are rare but serious problems that can lead to contracture and a need for revision surgery. The Keller Funnel is a medical device composed of a rip-stop nylon sleeve with a hydrophilic inner coating. One claim of the funnel is that it facilitates a "no touch" technique, thereby limiting contamination. To date, there are no data to support this claim. OBJECTIVES: The authors evaluate skin and breast parenchyma contamination with standard implantation techniques and the Keller funnel. METHODS: Insertion techniques were tested in two fresh cadavers. Smooth, round, moderate-plus silicone gel implants were placed for each experiment. To quantify the amount of skin contamination, a 2% w/v fluorescein paste was painted onto the cadaver thorax. After implantation, the implants were soaked in 250 mL of sterile water, and the fluorescence emission of the resulting solution was measured with an ultraviolet-visible spectrophotometer. To qualify the potential contamination from breast parenchyma, the cadaver breast tissue was swabbed with methicillin-sensitive Staphylococcus aureus, and the implant surfaces were cultured postimplantation. RESULTS: The funnel resulted in a 27-fold decrease in skin contact for all smooth gel implants (P = .00059). The amount of skin contact and potential contamination increased incrementally with increasing implant volume when either the funnel or digital implantation techniques were used. Bacterial contamination from breast parenchyma was two times more likely with the standard digital insertion technique (P = .06). CONCLUSIONS: The Keller funnel appears to significantly reduce the amount of skin contact and potential parenchyma contamination.
背景:乳房增大术后的显性感染和生物膜形成虽少见,但却是严重的问题,可导致挛缩和需要进行翻修手术。凯勒漏斗(Keller Funnel)是一种由带有亲水性内层的防撕裂尼龙套组成的医疗器械。该漏斗的一个特点是它可以实现“无接触”技术,从而限制污染。迄今为止,尚无数据支持这一说法。
目的:作者评估了标准植入技术和凯勒漏斗对皮肤和乳房实质的污染情况。
方法:在两个新鲜的尸体上测试了插入技术。每个实验都放置了光滑、圆形、中度加硅胶凝胶植入物。为了量化皮肤污染的程度,将 2% w/v 的荧光素糊涂在尸体的胸部。植入后,将植入物浸泡在 250 毫升无菌水中,并用紫外可见分光光度计测量所得溶液的荧光发射。为了确定来自乳房实质的潜在污染,用对甲氧西林敏感的金黄色葡萄球菌擦拭尸体乳房组织,并在植入后对植入物表面进行培养。
结果:对于所有光滑凝胶植入物,漏斗使皮肤接触减少了 27 倍(P =.00059)。当使用漏斗或数字植入技术时,皮肤接触量和潜在污染量随着植入物体积的增加而逐渐增加。标准数字插入技术使乳房实质的细菌污染的可能性增加了两倍(P =.06)。
结论:凯勒漏斗似乎显著减少了皮肤接触和潜在实质污染的量。
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