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Rampino Cordaro et al. Breast reconstruction, antibiotics and drains

vasoconstriction, reducing blood vessel gauge and The fourth variable analyzed was the presence of
thereby reducing the flow of blood. Furthermore, the any complementary treatments administered prior to
appearance of the scar is also adversely affected by surgery, and their various combinations (chemotherapy,
smoking, and it is therefore strongly suggested that radiotherapy, hormone therapy). The majority (72;
patients refrain from smoking in the 2-3 weeks before 83.7%) of the 86 patients in our sample had not
and after the operation. In the current study, however, received any complementary treatment, while the
none of the 3 women who tested positive admitted to remaining 14 had a fairly uniform distribution in terms
smoking, and it is therefore impossible to confirm the of the combination of possible treatment combinations.
literature findings in this sample.
Regarding radiotherapy (RT), the literature contains
The third variable considered in this study was the many studies which demonstrate a significant correlation
presence of co-morbidities. The majority of the 86 between preoperative RT and the development of an
patients studied (70; 81.4%) were not found to be SSI. Indeed, RT can provoke skin damage by the
affected by other pathologies. Only 10 patients occlusion or damage of the microvascular system and
(11.6%) had metabolic issues or autoimmune disease; chromosomal damage to the fibroblasts, inhibiting stem
infectious diseases were not present. There was no cell replication, angiogenesis, and collagen production.
comorbidity data available for 5 cases. This manifests during the final phases of treatment
as hyperemia and inflammation of the skin. Although
There are many studies in the literature that this is a frequent occurrence, it is easily remedied via
demonstrate a statistically significant correlation suitable topical treatment, and seldom necessitates
between the presence of co-morbidities in general the interruption of treatment. Nonetheless, connective
and an increased risk of contracting an SSI. [11-13] The tissue may also be damaged, and in the later stages
National Nosocomial Infections Surveillance System of RT, areas of sclerosis, fibrosis, and hypertrophy of
considers three key variables to be independently the pectoral muscle may occur. By provoking tissue
associated with the risk of SSI, namely: (1) a wound fibrosis and microvascular damage, therefore, RT
infected or contaminated surgically; (2) the duration may delay wound healing, and can be associated with
of the operation; and (3) an American Society of dehiscence, necrosis and infection. Moreover, when RT
Anesthesiologists (ASA) Physical Status Classification precedes reconstructive surgery, post-actinic damage
score greater than 2. Olsen et al. [14] also demonstrated may complicate the tissue expansion necessary to
that an ASA score of 2 or 3 is associated with a house the implant, as well as increase the risk of peri-
statistically significant risk of developing an SSI. prosthetic fibrosis and capsular contracture. [8,14]

Regarding metabolic function disorders, many The role of preoperative chemotherapy (CT) as a
researchers have set out to find a possible link potential peri-prosthetic infection risk factor has also
between diabetes mellitus, for example, and the risk been widely studied. Although contrasting results have
of peri-prosthetic infection. However, secondary to been reported, CT is known to cause myelosuppression
contrasting findings reported in the literature, this and neutropenia, and thereby potentially increase the
topic remains controversial. [8,14] As none of the three risk of infection. [8,16] In the current study, however, none
patients who tested positive in our study suffered from of the 3 patients whose samples tested positive for
any metabolic diseases, the authors can add little to microbial contamination had previously received CT. In
this debate. fact, of these 3 cases, only 1 (infected by Pseudomonas
aeruginosa) had undergone complementary treatment
There is no data in the literature suggesting that consisting of RT plus hormone therapy. Although
autoimmune diseases may represent a possible risk the size of the sample does not enable meaningful
factor for SSIs. Nevertheless, the potential role of the statistical analysis, the influence of RT cannot be ruled
drugs used to treat these conditions, e.g. steroids, out in this case.
cytostatics and immunosuppressors (azathioprine,
cyclosporine), have been widely studied. The The fifth variable considered was the use of post-
findings of several of these studies [15-17] appear to surgical wound drains. Indeed, the drains themselves
suggest that patients treated pre-operatively with may represent a risk factor for infection by promoting
immunosuppressant drugs or steroids do in fact run biofilm formation on the surface of the device, which
a greater risk of SSIs. However, none of the three may in turn promote the transfer of bacteria into the
patients who tested positive in the current study wound. It is also possible to contaminate the lower
had any concomitant diseases, and therefore no end of the drain during disconnection and emptying,
conclusions can be drawn in this regard. potentially causing intra-luminal infection and
28 Plastic and Aesthetic Research ¦ Volume 4 ¦ February 28, 2017