Salvage of infected breast implants with continuous peri-prosthetic antibiotic irrigation: a retrospective audit.
Association of Breast Surgery ePoster Library. Kelsall J. 05/15/17; 166331; P047
Jennett Kelsall
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Abstract
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Introduction
Infection in the setting of prosthetic breast reconstruction is a much feared complication as it may result in implant loss; causing psychological distress, poor cosmesis, further surgical procedures, and additional health care costs. Explantation in this setting has traditionally been the standard of care. Our institution has developed a protocol utilising intra-operative lavage, +/- exchange of the prosthesis, followed by continuous peri-prosthetic antibiotic irrigation for at least 48hrs; in order to attempt implant salvage in selected patients. We have audited our results and present our technique and outcomes for discussion.
Methods
A retrospective audit was undertaken of all infected breast prosthesis irrigation cases over the preceding 5 yrs at our institution, including immediate and delayed reconstructions and revision surgery with either implants or tissue expanders. Patient demographics, surgical and perioperative data, and final outcomes following irrigation were collected.
Results
Of 20 cases identified, 15 were successfully salvaged. Irrigation was undertaken for at least 48 hrs (range 2-6 days, median = 3). 14 had undergone immediate reconstruction, 2 delayed, and 4 revision procedures. The most common risk factor was obesity (13/20); others included concurrent fat grafting (4/20), smoking (4/20), previous irradiation (3/20); and diabetes (2/20). 12 had either an acellular dermal matrix or synthetic mesh in situ. 9 grew sensitive S.aureus, 2 grew Propionibacterium, and in 9 no organism was cultured.
Conclusion
Our protocol utilising intra-operative lavage and post-operative peri-prosthetic antibiotic irrigation is a simple technique. It offers an opportunity to salvage an infected implant reconstruction in selected patients.
Infection in the setting of prosthetic breast reconstruction is a much feared complication as it may result in implant loss; causing psychological distress, poor cosmesis, further surgical procedures, and additional health care costs. Explantation in this setting has traditionally been the standard of care. Our institution has developed a protocol utilising intra-operative lavage, +/- exchange of the prosthesis, followed by continuous peri-prosthetic antibiotic irrigation for at least 48hrs; in order to attempt implant salvage in selected patients. We have audited our results and present our technique and outcomes for discussion.
Methods
A retrospective audit was undertaken of all infected breast prosthesis irrigation cases over the preceding 5 yrs at our institution, including immediate and delayed reconstructions and revision surgery with either implants or tissue expanders. Patient demographics, surgical and perioperative data, and final outcomes following irrigation were collected.
Results
Of 20 cases identified, 15 were successfully salvaged. Irrigation was undertaken for at least 48 hrs (range 2-6 days, median = 3). 14 had undergone immediate reconstruction, 2 delayed, and 4 revision procedures. The most common risk factor was obesity (13/20); others included concurrent fat grafting (4/20), smoking (4/20), previous irradiation (3/20); and diabetes (2/20). 12 had either an acellular dermal matrix or synthetic mesh in situ. 9 grew sensitive S.aureus, 2 grew Propionibacterium, and in 9 no organism was cultured.
Conclusion
Our protocol utilising intra-operative lavage and post-operative peri-prosthetic antibiotic irrigation is a simple technique. It offers an opportunity to salvage an infected implant reconstruction in selected patients.
Introduction
Infection in the setting of prosthetic breast reconstruction is a much feared complication as it may result in implant loss; causing psychological distress, poor cosmesis, further surgical procedures, and additional health care costs. Explantation in this setting has traditionally been the standard of care. Our institution has developed a protocol utilising intra-operative lavage, +/- exchange of the prosthesis, followed by continuous peri-prosthetic antibiotic irrigation for at least 48hrs; in order to attempt implant salvage in selected patients. We have audited our results and present our technique and outcomes for discussion.
Methods
A retrospective audit was undertaken of all infected breast prosthesis irrigation cases over the preceding 5 yrs at our institution, including immediate and delayed reconstructions and revision surgery with either implants or tissue expanders. Patient demographics, surgical and perioperative data, and final outcomes following irrigation were collected.
Results
Of 20 cases identified, 15 were successfully salvaged. Irrigation was undertaken for at least 48 hrs (range 2-6 days, median = 3). 14 had undergone immediate reconstruction, 2 delayed, and 4 revision procedures. The most common risk factor was obesity (13/20); others included concurrent fat grafting (4/20), smoking (4/20), previous irradiation (3/20); and diabetes (2/20). 12 had either an acellular dermal matrix or synthetic mesh in situ. 9 grew sensitive S.aureus, 2 grew Propionibacterium, and in 9 no organism was cultured.
Conclusion
Our protocol utilising intra-operative lavage and post-operative peri-prosthetic antibiotic irrigation is a simple technique. It offers an opportunity to salvage an infected implant reconstruction in selected patients.
Infection in the setting of prosthetic breast reconstruction is a much feared complication as it may result in implant loss; causing psychological distress, poor cosmesis, further surgical procedures, and additional health care costs. Explantation in this setting has traditionally been the standard of care. Our institution has developed a protocol utilising intra-operative lavage, +/- exchange of the prosthesis, followed by continuous peri-prosthetic antibiotic irrigation for at least 48hrs; in order to attempt implant salvage in selected patients. We have audited our results and present our technique and outcomes for discussion.
Methods
A retrospective audit was undertaken of all infected breast prosthesis irrigation cases over the preceding 5 yrs at our institution, including immediate and delayed reconstructions and revision surgery with either implants or tissue expanders. Patient demographics, surgical and perioperative data, and final outcomes following irrigation were collected.
Results
Of 20 cases identified, 15 were successfully salvaged. Irrigation was undertaken for at least 48 hrs (range 2-6 days, median = 3). 14 had undergone immediate reconstruction, 2 delayed, and 4 revision procedures. The most common risk factor was obesity (13/20); others included concurrent fat grafting (4/20), smoking (4/20), previous irradiation (3/20); and diabetes (2/20). 12 had either an acellular dermal matrix or synthetic mesh in situ. 9 grew sensitive S.aureus, 2 grew Propionibacterium, and in 9 no organism was cultured.
Conclusion
Our protocol utilising intra-operative lavage and post-operative peri-prosthetic antibiotic irrigation is a simple technique. It offers an opportunity to salvage an infected implant reconstruction in selected patients.
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