Gowda Arvind U, Chopra Karan, Brown Emile N, Slezak Sheri, Rasko Yvonne
From the *Division of Plastic & Reconstructive Surgery, University of Maryland School of Medicine; and †Department of Plastic & Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD.
Ann Plast Surg. 2017 Feb;78(2):153-156. doi: 10.1097/SAP.0000000000000822.
BACKGROUND: Implant-based breast reconstruction is commonly performed by plastic surgeons worldwide. Bacterial contamination is of paramount concern because of its role in biofilm formation and capsular contracture. Plastic surgeons have adopted a variety of perioperative interventions in efforts to reduce implant contamination; however, definitive evidence supporting these practices is lacking. OBJECTIVE: The goal of this study was to assess current practice patterns aimed at reducing implant-related infections. METHODS: A 20-question survey assessing practices aimed at preventing breast implant-associated infections was generated and distributed via SurveyMonkey to members of the American Society of Plastic Surgery whose e-mail addresses were listed on the American Society of Plastic Surgery member Web site in April 2015. RESULTS: A total of 1979 invitations to participate in the survey were sent, and 253 responses were received during the 4-month study period. Of respondents, 81% were in private practice. Respondents averaged 21 ± 9 years in practice, and 34 ± 50 implant-based breast reconstructions were performed per year. A majority of surgeons used chlorhexidine to prepare the surgical site (52%), a triple antibiotic soak for the implant prior to placement (50%) and povidone-iodine for implant pocket irrigation (44%). A no-touch technique utilizing the Keller funnel was adopted by 69% of surgeons. Regarding antibiotic use in the postoperative period, first-generation cephalosporins (eg, cephalexin, cefadroxil) were used by a majority of surgeons (84%), and the most common duration was until drain removal (45%). CONCLUSIONS: There is considerable heterogeneity in surgical practices aimed at preventing bacterial contamination in implant-based breast reconstruction. Surgeons may benefit from high-level studies designed to create standardized evidence-based practice guidelines.
背景:全球范围内,整形外科医生普遍开展基于植入物的乳房重建手术。细菌污染因其在生物膜形成和包膜挛缩中所起的作用而备受关注。整形外科医生采取了多种围手术期干预措施以减少植入物污染;然而,缺乏支持这些做法的确切证据。 目的:本研究的目的是评估旨在减少与植入物相关感染的当前实践模式。 方法:编制了一份包含20个问题的调查问卷,用于评估预防乳房植入物相关感染的实践,并通过SurveyMonkey分发给美国整形外科协会的成员,这些成员的电子邮件地址于2015年4月列在美国整形外科协会成员网站上。 结果:共发出1979份参与调查的邀请,在4个月的研究期间收到了253份回复。在受访者中,81%为私人执业医生。受访者的平均从业年限为21±9年,每年进行34±50例基于植入物的乳房重建手术。大多数外科医生使用氯己定准备手术部位(52%),在植入前对植入物进行三联抗生素浸泡(50%),并用聚维酮碘冲洗植入腔隙(44%)。69%的外科医生采用了使用凯勒漏斗的无接触技术。关于术后抗生素的使用,大多数外科医生(84%)使用第一代头孢菌素(如头孢氨苄、头孢羟氨苄),最常见的用药持续时间是直到引流管拔除(45%)。 结论:在旨在预防基于植入物的乳房重建中细菌污染的手术实践中存在相当大的异质性。外科医生可能会从旨在制定标准化循证实践指南的高级别研究中受益。
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