Plastic surgeon in private practice in Medellin, Colombia.
Student, School of Medicine, Universidad de Antioquia, Medellín, Colombia.
Aesthet Surg J. 2019 Jul 12;39(8):848-859. doi: 10.1093/asj/sjy216.
Capsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC.
The authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach.
In June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients.
Pearson's chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed.
CHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.
包膜挛缩（CC）一直是一个悬而未决的问题。大量证据集中在细菌生物膜是其主要来源上。文献回顾表明，从贝克 III-IV 级 CC 患者取出的胶囊和植入物中发现的 90%以上的细菌属于常驻皮肤微生物组（表皮葡萄球菌，主要微生物）。术前使用适当的皮肤消毒剂可能是减少植入物污染和帮助预防生物膜相关 CC 的关键步骤。
作者试图通过乳晕入路比较两种不同的皮肤消毒剂：聚维酮碘（PVP-I）和葡萄糖酸洗必泰（CHG）对原发性乳房增大后 CC 比例的影响。
2014 年 6 月，美国医疗保健流行病学协会提议在没有含酒精消毒剂的情况下使用 CHG 进行术前皮肤准备，作为预防手术部位感染的策略。哥伦比亚一家外科中心的临床安全委员会决定此后将 PVP-I 改为 CHG 用于手术部位准备。回顾了 2014 年期间通过乳晕入路接受原发性乳房增大的 63 名患者的病历。在最初的 6 个月中，有 32 名患者使用了 PVP-I，之后有 31 名患者使用了 CHG。
Pearson 卡方检验比较亚组间 CC 比例差异有统计学意义。使用 PVP-I 进行消毒的患者 CC 比例更高。使用 CHG 时 CC 不存在。
CHG 作为原发性乳房增大手术的术前皮肤消毒剂，比 PVP-I 更能有效帮助预防生物膜相关 CC。
