Miami, Fla.; and Baltimore, Md. From the University of Miami Miller School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University; and the DeWitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine.
Plast Reconstr Surg. 2013 Mar;131(3):453-461. doi: 10.1097/PRS.0b013e31827c6d90.
The use of acellular dermal matrix in implant-based breast reconstruction has been described for improving inferolateral prosthesis coverage and support and inframammary fold reconstruction. Recommended guidelines for infection prophylaxis are the same as for any clean procedure-antibiotic administration only before surgery. Previous studies have demonstrated increased postoperative rates of infection and seroma associated with the use of acellular dermal matrix. The authors evaluated the impact of postoperative antibiotic prophylaxis on infection rates in postmastectomy expander-based breast reconstruction with acellular dermal matrix.
: A retrospective study reviewed data of 96 patients who underwent either immediate or delayed expander-based breast reconstruction using AlloDerm allogenic acellular dermal matrix. Infection rates were analyzed after patients received postoperative antibiotic prophylaxis for at least 48 hours compared with those who received only perioperative antibiotics.
Infection rates for breast reconstructions with a postoperative antibiotic course were 7.9 and 3.2 percent. Patients with only perioperative antibiotics had an infection rate of 31.6 percent. Infections were defined by the endpoint of implant removal. Patient demographics, comorbidities, and intraoperative variables were recorded. Uncontrolled variables were time course between mastectomy and reconstruction, nodal dissection, operative history, and whether reconstruction was unilateral or bilateral.
This study demonstrates significant differences in the rate of infection between the groups of patients undergoing the first stage of two-stage implant-based breast reconstruction who received postoperative antibiotic prophylaxis and the group that received only perioperative antibiotics. This study suggests that the optimal duration of postoperative antibiotic prophylaxis is at least 48 hours.
脱细胞真皮基质在基于假体的乳房重建中的应用已被描述为改善假体下外侧覆盖和支撑以及乳房下皱襞重建。预防感染的推荐指南与任何清洁手术相同——仅在手术前使用抗生素。先前的研究表明，使用脱细胞真皮基质与术后感染和血清肿的发生率增加有关。作者评估了术后抗生素预防措施对使用脱细胞真皮基质的即刻或延迟扩张器乳房重建术后感染率的影响。
回顾性研究分析了 96 例接受同种异体脱细胞真皮基质 AlloDerm 即刻或延迟扩张器乳房重建的患者数据。与仅接受围手术期抗生素治疗的患者相比，接受至少 48 小时术后抗生素预防治疗的患者的感染率进行了分析。
接受术后抗生素疗程的乳房重建感染率分别为 7.9%和 3.2%。仅接受围手术期抗生素治疗的患者感染率为 31.6%。感染的定义是植入物去除的终点。记录了患者的人口统计学、合并症和术中变量。未控制的变量包括乳房切除术和重建之间的时间过程、淋巴结清扫、手术史以及重建是单侧还是双侧。
本研究表明，接受两阶段植入物乳房重建第一阶段的患者中，接受术后抗生素预防治疗的患者与仅接受围手术期抗生素治疗的患者之间的感染率存在显著差异。本研究表明，术后抗生素预防的最佳持续时间至少为 48 小时。
