Chopra Karan, Gowda Arvind U, McNichols Colton H L, Brown Emile N, Slezak Sheri, Rasko Yvonne
From the *Department of Plastic & Reconstructive Surgery, The Johns Hopkins Hospital; †Division of Plastics & Reconstructive Surgery, The University of Maryland, Baltimore, MD; ‡Division of Plastic Surgery, Yale University, New Haven, CT; §Division of Plastic & Reconstructive Surgery, The University of Maryland, Baltimore, MD.
Ann Plast Surg. 2017 Jun;78(6):629-632. doi: 10.1097/SAP.0000000000000942.
Breast augmentation is one of the most commonly performed aesthetic surgery procedures worldwide. Bacterial contamination is of paramount concern due to 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.
The goal of this study was to assess current practice patterns aimed at reducing implant-related infections in breast augmentation and comparing them to current evidence-based medicine recommendations.
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 electronic mail addresses were listed on the American Society of Plastic Surgery member website in April 2015.
A total of 253 responses were received from the survey. Of the respondents, 81% were in private practice. Respondents averaged 21 ± 9 years in practice, and 69 ± 111 breast augmentations performed per year. A majority of surgeons used Chlorhexidine to prepare the surgical site (45%) and triple antibiotic solution both as a soak for the implant before placement (40%) as well as for implant pocket irrigation (47%). A no-touch technique using the Keller Funnel was adopted by 42% of surgeons. Regarding antibiotic use in the postoperative period, first-generation cephalosporins were used by the majority of respondents (79%), and the most common duration was for 4 to 6 days (45%).
Although there is heterogeneity in specific aspects of antimicrobial prophylaxis during breast augmentation, there is a clear trend toward practice modification geared towards preventing bacterial contamination in breast augmentation. Surgeons may benefit from high-level studies designed to create standardized evidence-based practice guidelines.
隆胸是全球最常见的美容外科手术之一。由于细菌污染在生物膜形成和包膜挛缩中所起的作用，其备受关注。整形外科医生已采取多种围手术期干预措施以减少植入物污染，但缺乏支持这些做法的确切证据。
本研究的目的是评估旨在减少隆胸手术中与植入物相关感染的当前实践模式，并将其与当前循证医学建议进行比较。
通过SurveyMonkey生成了一份包含20个问题的调查问卷，以评估旨在预防乳房植入物相关感染的实践，并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在2015年4月列在美国整形外科协会成员网站上。
共收到253份调查问卷回复。在受访者中，81%为私人执业医生。受访者的平均执业年限为21±9年，每年平均进行69±111例隆胸手术。大多数外科医生使用氯己定准备手术部位（45%），并使用三联抗生素溶液浸泡植入物（40%）以及冲洗植入腔隙（47%）。42%的外科医生采用使用凯勒漏斗的无接触技术。关于术后抗生素的使用，大多数受访者使用第一代头孢菌素（79%），最常见的使用时长为4至6天（45%）。
尽管隆胸手术中抗菌预防的具体方面存在异质性，但明显存在朝着预防隆胸手术中细菌污染的实践改进趋势。外科医生可能会从旨在制定标准化循证实践指南的高级研究中受益。
