Prantl Lukas, Momeni Arash, Brebant Vanessa, Kuehlmann Britta, Heine Norbert, Biermann Niklas, Brix Eva
University Center of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, Calif.
Plast Reconstr Surg Glob Open. 2020 Jan 24;8(1):e2590. doi: 10.1097/GOX.0000000000002590. eCollection 2020 Jan.
The use of systemic prophylactic antibiotics to reduce surgical-site infection in esthetic breast surgery remains controversial, although the majority of surgeons prefer to utilize antibiotics to prevent infection. Nonetheless, postoperative acute and subclinical infection and capsular fibrosis are among the most common complications following implant-based breast reconstruction. After esthetic breast augmentation, up to 2.9% of women develop infection, with an incidence rate of 1.7% for acute infections and 0.8% for late infections. After postmastectomy reconstruction (secondary reconstruction), the rates are even higher. The microorganisms seen in acute infections are Gram-positive, whereas subclinical late infections involving microorganisms are typically Gram-negative and from normal skin flora with low virulence. In primary implantation, a weight-based dosing of cefazolin is adequate, an extra duration of antibiotic cover does not provide further reduction in superficial or periprosthetic infections. Clindamycin and vancomycin are recommended alternative for patients with -lactam allergies. The spectrum of microorganism found in late infections varies (Gram-positive and Gram-negative), and the antibiotic prophylaxis (fluoroquinolones) should be extended by vancomycin and according to the antibiogram when replacing implants and in secondary breast reconstruction, to target microorganisms associated with capsular contracture. All preoperative antibiotics should be administered <60 minutes before incision to guarantee high serum levels during surgical procedure.
尽管大多数外科医生倾向于使用抗生素来预防感染，但在美容乳房手术中使用全身性预防性抗生素以减少手术部位感染仍存在争议。尽管如此，术后急性和亚临床感染以及包膜纤维化是基于植入物的乳房重建后最常见的并发症。在美容隆乳术后，高达2.9%的女性会发生感染，急性感染的发生率为1.7%，晚期感染的发生率为0.8%。在乳房切除术后重建（二期重建）后，发生率甚至更高。急性感染中发现的微生物为革兰氏阳性菌，而涉及微生物的亚临床晚期感染通常为革兰氏阴性菌，且来自毒力较低的正常皮肤菌群。在初次植入时，基于体重的头孢唑林给药就足够了，额外延长抗生素覆盖时间并不能进一步降低浅表或假体周围感染的发生率。对于有β-内酰胺类过敏的患者，推荐使用克林霉素和万古霉素作为替代药物。晚期感染中发现的微生物谱各不相同（革兰氏阳性菌和革兰氏阴性菌），在更换植入物和二期乳房重建时，应根据抗菌谱，用万古霉素延长抗生素预防（氟喹诺酮类），以针对与包膜挛缩相关的微生物。所有术前抗生素应在切口前<60分钟给药，以确保手术过程中血清水平较高。
