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Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols

Infection following implant-based breast reconstruction (IBBR) results in increased rates of hospital readmission, reoperation, patient and hospital expenses, and reconstructive failure. IBBR is a complex, multistep procedure, and there is a relative lack of high-quality plastic surgery evidence reg...

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Autores principales: Baker, Nusaiba F., Brown, Owen, Hart, Alexandra M., Danko, Dora, Stewart, Christopher M., Thompson, Peter W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8939924/
https://www.ncbi.nlm.nih.gov/pubmed/35350150
http://dx.doi.org/10.1097/GOX.0000000000004208
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author Baker, Nusaiba F.
Brown, Owen
Hart, Alexandra M.
Danko, Dora
Stewart, Christopher M.
Thompson, Peter W.
author_facet Baker, Nusaiba F.
Brown, Owen
Hart, Alexandra M.
Danko, Dora
Stewart, Christopher M.
Thompson, Peter W.
author_sort Baker, Nusaiba F.
collection PubMed
description Infection following implant-based breast reconstruction (IBBR) results in increased rates of hospital readmission, reoperation, patient and hospital expenses, and reconstructive failure. IBBR is a complex, multistep procedure, and there is a relative lack of high-quality plastic surgery evidence regarding “best practices” in the prevention of implant infections. In the absence of strong data, standardizing procedures based on available evidence can reduce error and improve efficacy and outcomes. METHODS: We performed a focused literature review of the available evidence supporting specific interventions for infection prevention in the preoperative, intraoperative, and postoperative phases of care that are applicable to IBBR. In addition, we examined previously published standardized perioperative protocols for implant reconstruction. RESULTS: Preoperative, intraoperative, and postoperative planning and organization is crucial in IBBR. Preoperative planning involves skin decolonization in advance of surgery with either chlorhexidine gluconate or mupirocin. Intraoperative methods that have shown potential benefit include double-gloving, breast pocket irrigation, separate closing instruments, and the utilization of “no-touch” techniques. In the postoperative period, the duration of drain removal and postoperative antibiotic administration play an important role in the prevention of surgical site infection. CONCLUSIONS: There is a crucial need to establish an evidence-based set of “best practices” for IBBR, and there exists a paucity of evidence in the breast literature. These data can be utilized to develop a standardized protocol as part of a rigorous quality improvement methodology.
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spelling pubmed-89399242022-03-28 Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols Baker, Nusaiba F. Brown, Owen Hart, Alexandra M. Danko, Dora Stewart, Christopher M. Thompson, Peter W. Plast Reconstr Surg Glob Open Breast Infection following implant-based breast reconstruction (IBBR) results in increased rates of hospital readmission, reoperation, patient and hospital expenses, and reconstructive failure. IBBR is a complex, multistep procedure, and there is a relative lack of high-quality plastic surgery evidence regarding “best practices” in the prevention of implant infections. In the absence of strong data, standardizing procedures based on available evidence can reduce error and improve efficacy and outcomes. METHODS: We performed a focused literature review of the available evidence supporting specific interventions for infection prevention in the preoperative, intraoperative, and postoperative phases of care that are applicable to IBBR. In addition, we examined previously published standardized perioperative protocols for implant reconstruction. RESULTS: Preoperative, intraoperative, and postoperative planning and organization is crucial in IBBR. Preoperative planning involves skin decolonization in advance of surgery with either chlorhexidine gluconate or mupirocin. Intraoperative methods that have shown potential benefit include double-gloving, breast pocket irrigation, separate closing instruments, and the utilization of “no-touch” techniques. In the postoperative period, the duration of drain removal and postoperative antibiotic administration play an important role in the prevention of surgical site infection. CONCLUSIONS: There is a crucial need to establish an evidence-based set of “best practices” for IBBR, and there exists a paucity of evidence in the breast literature. These data can be utilized to develop a standardized protocol as part of a rigorous quality improvement methodology. Lippincott Williams & Wilkins 2022-03-22 /pmc/articles/PMC8939924/ /pubmed/35350150 http://dx.doi.org/10.1097/GOX.0000000000004208 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Breast
Baker, Nusaiba F.
Brown, Owen
Hart, Alexandra M.
Danko, Dora
Stewart, Christopher M.
Thompson, Peter W.
Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols
title Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols
title_full Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols
title_fullStr Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols
title_full_unstemmed Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols
title_short Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols
title_sort preventing infection in implant-based breast reconstruction: evaluating the evidence for common practices and standardized protocols
topic Breast
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8939924/
https://www.ncbi.nlm.nih.gov/pubmed/35350150
http://dx.doi.org/10.1097/GOX.0000000000004208
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