Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea.
Department of Plastic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Ulsan, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2023 Sep;84:191-202. doi: 10.1016/j.bjps.2023.05.025. Epub 2023 May 19.
Acellular dermal matrix (ADM) is generally used on implant-based breast operations; However, it can increase surgical site infection. Many immersion solutions are applied to ADM, however, the most effective solution is unknown. The purpose of this study is to determine the effect of different solutions on the biofilm formation and mechanical properties of ADM.
Aseptic porcine-derived ADMs were immersed in 5 different solutions for 30 min; sterile normal saline, 10% povidone-iodine, 0.5% chlorhexidine, antibiotics (cefazolin, gentamicin, and vancomycin), and taurolidine. They are transferred to 10 ml suspension of methicillin-sensitive/resistant Staphylococcus aureus (MSSA/MRSA) or Staphylococcus epidermidis and an overnight culture was performed. After rinsing and sonication to obtain the biofilm on ADM, colony forming unit (CFU) was measured. In addition, the maximum load before ADM deformation and the elongation length of ADM at the start of the maximum load was determined.
Regardless of strains, povidone-iodine, chlorhexidine, and taurolidine group had lower CFUs than the saline group with statistical significance. Meanwhile, the antibiotics group did not show statistical difference from the saline group. Moreover, only taurolidine group showed higher tensile strength (MRSA, p = 0.0003; S. epidermidis, p = 0.0023) and elongation length (MSSA, p = 0.0015) than the saline group. The antibiotics and chlorhexidine group yielded lower tensile strength and elongation length than the povidone-iodine and taurolidine groups.
It was suggested that the 10% povidone-iodine or taurolidine solution is effective. In contrast, the antibiotics solution could be considered as an effective intraoperative solution.
脱细胞真皮基质（ADM）通常用于基于植入物的乳房手术；然而，它会增加手术部位感染的风险。许多浸渍溶液都应用于 ADM，但最有效的溶液尚不清楚。本研究旨在确定不同溶液对 ADM 生物膜形成和机械性能的影响。
无菌猪源 ADM 在 5 种不同溶液中浸泡 30 分钟；无菌生理盐水、10%聚维酮碘、0.5%洗必泰、抗生素（头孢唑林、庆大霉素和万古霉素）和牛磺罗定。然后将其转移到 10ml 甲氧西林敏感/耐药金黄色葡萄球菌（MSSA/MRSA）或表皮葡萄球菌的悬浮液中进行过夜培养。冲洗和超声处理以获得 ADM 上的生物膜后，测量菌落形成单位（CFU）。此外，还测定了 ADM 变形前的最大载荷和最大载荷开始时 ADM 的伸长长度。
无论菌株如何，聚维酮碘、洗必泰和牛磺罗定组的 CFU 均低于生理盐水组，差异具有统计学意义。同时，抗生素组与生理盐水组无统计学差异。此外，只有牛磺罗定组表现出较高的拉伸强度（MRSA，p=0.0003；表皮葡萄球菌，p=0.0023）和伸长长度（MSSA，p=0.0015）比生理盐水组。抗生素和洗必泰组的拉伸强度和伸长长度均低于聚维酮碘和牛磺罗定组。
建议使用 10%聚维酮碘或牛磺罗定溶液。相比之下，抗生素溶液可被视为有效的术中溶液。
