Anthony Ojochonu D, Seth Ishith, Rozen Warren M
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, VIC, Australia.
Aesthetic Plast Surg. 2025 Jan 23. doi: 10.1007/s00266-025-04660-y.
In implant-based breast surgery, microbial contamination of implant surfaces predisposes complications such as overt periprosthetic infection and has been linked to capsular contracture (CC). Anti-microbial practices, including povidone-iodine (PVP-I) breast pocket irrigation, are routinely employed to minimise these risks. No standardised protocol for using this antiseptic exists, particularly concerning the ideal concentration. This review investigates how PVP-I concentration affects outcomes in these procedures while highlighting research gaps.
Using PRISMA-ScR guidelines, a systematic search was conducted across MEDLINE, Embase, Scopus, and PubMed databases from their inception to June 2024. Studies were screened using pre-determined criteria for inclusion. The methodological quality of relevant studies was assessed using the MINORS tool. Data regarding basic characteristics, PVP-I irrigation implementation, and outcomes (primarily periprosthetic infection and CC) were extracted for analysis.
Nine articles, primarily observational studies, and retrospective analyses were included. These mainly focused on breast augmentation with a few including reconstruction. There was considerable heterogeneity in surgical techniques, and reported PVP-I concentrations ranged from 4 to 20%. This was further confounded by frequent mixing of irrigation solution with antibiotics. Although infection and CC rates were frequently reported, most studies did not specify outcome data for patients receiving PVP-I irrigation.
While PVP-I irrigation is extensively used in implant surgeries, the current evidence base is insufficient to determine the optimal concentration and application techniques. This review underscores the need for further detailed research to establish evidence-based guidelines for PVP-I use, aiming to improve patient care and surgical outcomes in breast surgery.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
在基于植入物的乳房手术中，植入物表面的微生物污染易引发诸如明显的假体周围感染等并发症，并与包膜挛缩（CC）有关。包括聚维酮碘（PVP-I）乳房腔隙冲洗在内的抗菌措施被常规用于降低这些风险。目前尚无使用这种防腐剂的标准化方案，尤其是关于理想浓度方面。本综述研究了PVP-I浓度如何影响这些手术的结果，同时突出研究空白。
按照PRISMA-ScR指南，对MEDLINE、Embase、Scopus和PubMed数据库从建库至2024年6月进行了系统检索。使用预先确定的纳入标准对研究进行筛选。使用MINORS工具评估相关研究的方法学质量。提取有关基本特征、PVP-I冲洗实施情况和结果（主要是假体周围感染和CC）的数据进行分析。
纳入了9篇文章，主要是观察性研究和回顾性分析。这些研究主要聚焦于隆乳术，少数包括乳房重建术。手术技术存在相当大的异质性，报告的PVP-I浓度范围为4%至20%。冲洗液与抗生素频繁混合使情况更加复杂。尽管感染率和CC发生率经常被报告，但大多数研究未明确接受PVP-I冲洗患者的结果数据。
虽然PVP-I冲洗在植入物手术中被广泛使用，但目前的证据基础不足以确定最佳浓度和应用技术。本综述强调需要进一步开展详细研究，以建立基于证据的PVP-I使用指南，旨在改善乳房手术中的患者护理和手术结果。
证据水平III：本刊要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
