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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Evidence-based protocol for infection control in immediate implant-based breast reconstruction
Randall O Craft1, Branimir Damjanovic, Amy S Colwell
1Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. rcraft@partners.org
Annals of Plastic Surgery
|September 12, 2012
Summary
Reducing surgical site infections in breast reconstruction involves nasal swabs to treat Staphylococcus aureus before surgery. Protocols using mupirocin, chlorhexidine, and specific irrigation solutions can decrease infection rates.
Area of Science:
- Plastic Surgery
- Infectious Disease Control
Background:
- Immediate breast reconstruction has high infection rates.
- Staphylococcus aureus is a common cause of surgical site infections.
Purpose of the Study:
- To evaluate an evidence-based protocol to decrease infection rates in immediate breast reconstruction.
- To assess the efficacy of nasal decolonization and specific antiseptic skin preparations.
Main Methods:
- Literature search for infection control strategies.
- Nasal swab evaluation for Staphylococcus aureus (methicillin-sensitive and methicillin-resistant strains).
- Analysis of antiseptic skin preparation and intraoperative irrigation solutions.
Main Results:
- Nasal swabs identified methicillin-sensitive S. aureus, streptococcus, and gram-negative rods in 14 of 120 patients.
- Evidence supports chlorhexidine-alcohol over povidone-iodine for skin prep.
- Povidone-iodine and triple antibiotic solutions showed benefits for breast pocket irrigation.
Conclusions:
- An evidence-based protocol incorporating nasal decolonization and optimized antiseptic use may reduce infection rates.
- Perioperative antibiotic management was altered based on nasal swab results.
- Further research on cost and efficacy is needed.
