Klein Gabriel M, Nasser Ahmed E, Phillips Brett T, Gersch Robert P, Fourman Mitchell S, Lilo Sarit E, Fritz Jason R, Khan Sami U, Dagum Alexander B, Bui Duc T
Division of Plastic Surgery, Department of Surgery, Stony Brook University of Medical Center, Stony Brook, N.Y.; Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham N.C.; Department of Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pa.; Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa; and The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhassett, N.Y.
Plast Reconstr Surg Glob Open. 2016 Jun 28;4(6):e761. doi: 10.1097/GOX.0000000000000705. eCollection 2016 Jun.
Postoperative infections are a major complication associated with tissue-expander-based breast reconstruction. The use of acellular dermal matrix (ADM) in this surgery has been identified as a potential reservoir of infection, prompting the development of sterile ADM. Although aseptic and sterile ADMs have been investigated, no study has focused on the occurrence and clinical outcome of bacterial colonization before implantation.
Samples of aseptic AlloDerm, sterile Ready-To-Use AlloDerm, and AlloMax were taken before implantation. These samples were incubated in Tryptic soy broth overnight before being streaked on Trypticase soy agar, MacConkey agar, and 5% blood agar plates for culture and incubated for 48 hours. Culture results were cross-referenced with patient outcomes for 1 year postoperatively.
A total of 92 samples of ADM were collected from 63 patients. There were 15 cases of postoperative surgical site infection (16.3%). Only 1 sample of ADM (AlloMax) showed growth of Escherichia coli, which was likely a result of contamination. That patient did not develop any infectious sequelae. Patient outcomes showed no difference in the incidence of seroma or infection between sterile and aseptic ADMs.
This study evaluates the microbiology of acellular dermal matrices before use in breast reconstruction. No difference was found in the preoperative bacterial load of either aseptic or sterile ADM. No significant difference was noted in infection or seroma formation. Given these results, we believe aseptic processing used on ADMs is equivalent to sterile processing in our patient cohort in terms of clinical infection and seroma occurrence postoperatively.
术后感染是基于组织扩张器的乳房重建相关的主要并发症。在该手术中使用脱细胞真皮基质（ADM）已被确定为潜在的感染源，促使了无菌ADM的研发。尽管已对无菌和非无菌ADM进行了研究，但尚无研究关注植入前细菌定植的发生情况及临床结果。
在植入前采集非无菌的AlloDerm、无菌的即用型AlloDerm和AlloMax样本。这些样本在胰蛋白胨大豆肉汤中过夜培养，然后划线接种于胰蛋白酶大豆琼脂、麦康凯琼脂和5%血琼脂平板上进行培养，并孵育48小时。将培养结果与患者术后1年的结局进行交叉对照。
共从63例患者中收集了92份ADM样本。术后手术部位感染15例（16.3%）。仅1份ADM样本（AlloMax）显示有大肠杆菌生长，这可能是污染所致。该患者未出现任何感染后遗症。患者结局显示，无菌和非无菌ADM在血清肿或感染发生率方面无差异。
本研究评估了脱细胞真皮基质在用于乳房重建前的微生物学情况。无菌或非无菌ADM的术前细菌载量未发现差异。在感染或血清肿形成方面未观察到显著差异。基于这些结果，我们认为就术后临床感染和血清肿发生情况而言，ADM上使用的无菌处理与我们患者队列中的无菌处理相当。
