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Use of the Biopatch Drain Dressing to Reduce Infection Rates in Expander/Implant-Based Breast Reconstruction
Keith M. Blechman, MD, Patrick L. Reavey, MD, Katie Weichman, MD, Stelios Wilson, BA, Jamie P. Levine, MD, Mihye Choi, MD, Nolan S. Karp, MD.
New York University School of Medicine, New York, NY, USA.
Background: Infection rates for implant-based breast reconstructions are as high as 25%. Surgical drains may potentiate these complications by providing a route of entry for skin flora. To counteract this, we have recently begun covering drains with the Biopatch (Ethicon, Somerville, NJ), a dressing composed of a sterile foam disk impregnated with the antiseptic chlorhexidine gluconate. Randomized, controlled trials have demonstrated that the Biopatch reduces intravenous catheter-related bloodstream infections, but no data is published regarding its use with periprosthetic drains.
Methods: An IRB-approved, retrospective review of immediate breast reconstructions with either tissue expanders or implants performed at New York University Langone Medical Center from January to October 2011 was conducted. Patients were divided into two groups: (1) those who received the Biopatch drain dressing and (2) controls who did not. Office and hospital charts of all patients were reviewed. Infection rates, including minor infections treated with oral antibiotics, and major infections treated with intravenous antibiotics and explantation, were compared between groups using univariate analysis.
Results: A total of 170 consecutive breasts were included: 60 in the Biopatch group and 110 in the control group. Patients had similar preoperative and intraoperative characteristics. A threefold decrease in the overall infection rate was seen in the Biopatch group versus the control group (3% vs. 10%, p=0.14). Interestingly, in the subgroup of patients that had an inferolateral sling placed with either AlloDerm or SeriScaffold, a dramatic reduction in the infection rate was noted (0% in the Biopatch group vs 21% in the control, p=0.047).
Conclusions: Although limited by its design, this study provides the first reported data suggesting that use of the Biopatch as a drain dressing reduces infection rates in implant-based breast reconstruction. Given its low cost (less than \ per disk) and ease of use, the Biopatch is an important adjunct to potentially prevent infectious complications in these patients. We are currently performing a randomized, controlled trial at our institution to fully evaluate its effectiveness.
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