Gabriel Allen, Sigalove Steven, Pfaffenberger Maci, Eldenburg Elizabeth, Gold Rebecca, O'Rorke Erin, Maxwell G Patrick
Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, Calif.
Private Practice, Scottsdale Plastic Surgery, Scottsdale, Ariz.
Plast Reconstr Surg Glob Open. 2020 Apr 23;8(4):e2758. doi: 10.1097/GOX.0000000000002758. eCollection 2020 Apr.
Povidone-iodine has been traditionally used as an antimicrobial agent to irrigate the breast pocket and rinse the prosthesis before placement in the pocket. Use of povidone-iodine with breast implants was banned from 2000 to 2017. During this period, acellular dermal matrix (ADM) was introduced to breast surgery. In nonclinical studies, povidone-iodine can impair collagen synthesis and kill fibroblasts. Cellular repopulation was critical for ADM integration. Whether povidone-iodine impacts ADM integration was unknown.
Patients who underwent immediate, prepectoral, 2-staged breast reconstruction were included in this retrospective study. Study population was divided into povidone-iodine-treated patients and triple-antibiotic-treated patients. The breast pockets were rinsed with the antimicrobial agent, and the prostheses and ADMs were presoaked in the agent perioperatively. At implant exchange, the extent of ADM integration was clinically assessed. ADM integration was defined as >25% of matrix vascularization. ADM integration and postoperative complications were compared between the groups.
A total of 111 patients (257 reconstructions) were included-58 patients (111 reconstructions) were exposed to povidone-iodine and 53 patients (97 reconstructions) to triple-antibiotic solution. ADM integration was noted in 97% of breasts in each group. Integrated matrices appeared healthy, had no signs of foreign body reaction, and demonstrated punctate bleeding. Complications did not differ between the groups, including the rate of infections, seroma, and expander loss.
Irrigation of the breast pocket and presoaking of the prosthesis and ADM with povidone-iodine appear to have no adverse consequences on clinical outcomes and did not impede matrix integration.
聚维酮碘传统上用作抗菌剂，用于冲洗乳房腔隙并在将假体放入腔隙前冲洗假体。2000年至2017年期间，乳房植入手术中禁止使用聚维酮碘。在此期间，脱细胞真皮基质（ADM）被引入乳房手术。在非临床研究中，聚维酮碘会损害胶原蛋白合成并杀死成纤维细胞。细胞再填充对ADM整合至关重要。聚维酮碘是否会影响ADM整合尚不清楚。
本回顾性研究纳入了接受即刻、胸肌前、两阶段乳房重建的患者。研究人群分为聚维酮碘治疗组和三联抗生素治疗组。用抗菌剂冲洗乳房腔隙，并在围手术期将假体和ADM浸泡在该药剂中。在更换植入物时，对ADM整合程度进行临床评估。ADM整合定义为基质血管化>25%。比较两组之间的ADM整合情况和术后并发症。
共纳入111例患者（257次重建）——58例患者（111次重建）使用了聚维酮碘，53例患者（97次重建）使用了三联抗生素溶液。每组中97%的乳房观察到ADM整合。整合的基质看起来健康，没有异物反应迹象，并出现点状出血。两组之间的并发症无差异，包括感染、血清肿和扩张器丢失率。
用聚维酮碘冲洗乳房腔隙以及将假体和ADM浸泡似乎对临床结果没有不良影响，也不会妨碍基质整合。
