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Rampino Cordaro et al. Breast reconstruction, antibiotics and drains

to declare. First, as the operations were performed MM, Hoskin T, Baddour LM, Degnim AC. Postoperative prophylactic
in more than one hospital, rigid standardization of antibiotics and surgical site infection rates in breast surgery patients.
the study protocol was not possible. Although the Ann Surg Oncol 2009;16:2464-9.
medical and nursing staff had been trained to adhere 2. Khan UD. Breast augmentation, antibiotic prophylaxis, and infection:
comparative analysis of 1,628 primary augmentation mammoplasties
to the rules of the study, several (16) cases had to be assessing the role and efficacy of antibiotics prophylaxis duration.
excluded due to procedural inaccuracies. The major Aesthetic Plast Surg 2010;34:42-7.
limitation of the study, however, was the small sample 3. Hedick TL, Smith PW, Gazoni LM, Sawyer RG. The appropriate use
size, which prevents the conclusions from achieving of antibiotics in surgery: a review of surgical infections. Curr Probl
statistical significance. Surg 2007;44:635-75.
4. Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS,
Nevertheless, patients have continued to be added Wittmann DH. Anti-microbial prophylaxis for surgical wounds.
to the study group, with a view to increasing the data 5. Guidelines for clinical care. Arch Surg 1993;128:79-88.
Rohrich RJ, Rios JL. The role of prophylactic antibiotics in plastic
available and addressing certain secondary objectives. surgery: whom are we treating? Plast Reconstr Surg 2003;112:617-8.
Specifically, the authors wish to evaluate, via 6. Perrotti JA, Castor SA, Perez PC, Zins JE. Antibiotic use in aesthetic
microbiological analysis of the peri-prosthetic pocket surgery: a national survey and literature review. Plast Reconstr Surg
during revision surgery, whether subclinical colonization 2002;109:1685-93; discussion 1694-5.
persists upon implant replacement, and whether or not 7. Lyle WG, Outlaw K, Krizek TJ, Koss N, Payne WG, Robson MC.
bacterial colonization leads to a greater incidence of Prophylactic antibiotics in plastic surgery: trends of use over 25 years
capsular contracture. It will also be interesting to follow 8. of an evolving specialty. Aesth Surg J 2003;23:177-83.
Nahabedian MY, Tsangaris T, Manson PN. Infectious complications
the progress of the patient whose peri-prosthetic fluid following breast reconstruction with expanders and implants. Plast
tested positive for Propionibacterium acnes upon Reconstr Surg 2003;112:467-76.
drain removal, despite an absence of signs of clinical 9. Cordeiro PG, McCarthy CM. A single surgeon’s 12-year experience
infection. In particular, the patient will be monitored with tissue expander/implant breast reconstruction: part I. A
for any sign of capsular contracture, which would lend prospective analysis of early complications. Plast Reconstr Surg
weight to the literature hypothesis that peri-prosthetic 2006;118:825-31.
infection is an important risk factor for this event in the 10. Ernori TG, Gaynes RP. An overview of nosocomial infections,
long term. Should contracture indeed occur, it will also including the role of the microbiology laboratory. Clin Microbiol Rev
1993;6:428-42.
be interesting to note whether the microbial species 11. Geubbels EL, Grobbee DE, Vandenbroucke-Grauls CM, Wille JC, de
isolated from the capsule is the same as that present Boer AS. Improved risk adjustment for comparison of surgical site
in the drain fluid. infection rates. Infect Control Hosp Epidemiol 2006;27:1330-9.
12. Clegg HW, Bertagnoll P, Hightower AW, Baine WB. Mammaplasty-
Despite the above-mentioned limitations, the results of associated mycobacterial infection: a survey of plastic surgeons. Plast
this preliminary study are encouraging, demonstrating Reconstr Surg 1983;72:165-9.
that the guidelines regarding short-term AP are indeed 13. Courtiss EH, Goldwyn RM, Anastasi GW. The fate of breast implants
with infection around them. Plast Reconstr Surg 1979;63:812-6.
effective. However, it remains to be demonstrated 14. Olsen MA, Lefta M, Dietz JR, Brandt KE, Aft R, Matthews R,
that not prolonging prophylaxis does not statistically Mayfield J, Fraser VJ. Risk factors for surgical site infection after
increase the risk of surgical failure, and does not major breast operation. J Am Coll Surg 2008;207:326-35.
therefore expose either the patient or surgeon to the 15. Donlan RM, Costerton JW. Biofilms: survival mechanisms of
burden of complications, whether major or minor. clinically relevant microorganisms. Clin Microbiol Rev 2002;15:167-
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Financial support and sponsorship 16. Yule GJ, Concannon MJ, Croll G, Puckett CL. Is there liability with
chemotherapy following immediate breast reconstruction? Plast
None. Reconstr Surg 1996;97:969-73.
17. Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton
Conflicts of interest TM. Identifying patients at high risk of surgical wound infection.
There are no conflicts of interest. A simple multivariate index of patient usceptibility and wound
contamination. Am J Epidemiol 1985;121:206-15.
18. Felippe WA, Werneck GL, Santoro-Lopes G. Surgical site infection
Patient consent among women discharged with a drain in situ after breast cancer
All patients signed informed consent. surgery. World J Surg 2007;31:2293-9; discussion 2300-1.
19. Raves JJ, Slifkin M, Diamond DL. A bacteriologic study comparing
Ethics approval closed suction and simple conduit drainage. Am J Surg 1984;148:618-
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The Institutional Review Board approved this study. 20. McCarthy CM, Mehrara BJ, Riedel E, Davidge K, Hinson A, Disa JJ,
Cordeiro PG, Pusic AL. Predicting complications following expander/
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operative clinical risk. Plast Reconstr Surg 2008;121:1886-92.
1. Throckmorton AD, Boughey JC, Boostrom SY, Holifield AC, Stobbs 21. McCarthy CM, Disa JJ, Pusic AL, Mehrara BJ, Cordeiro PG. The
30 Plastic and Aesthetic Research ¦ Volume 4 ¦ February 28, 2017