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Antimicrobial Irrigation Difference In Implant-based Reconstruction: Triple-antibiotic Solution Versus Chlorhexidine-gluconate Based Solution
Ryan P. Lin, MD1, Alexandra Junn, MD
1, Rachel N. Rohrich, BS
1, Sami Ferdousian, BS
1, Isabel A. Snee, BS
1, Danny Chamaa, BS
1, Lucy De La Cruz, MD
2, Samer F. Jabbour, MD
1, Kenneth L. Fan, MD
1.
1MedStar Georgetown University Hospital Department of Plastic and Reconstructive Surgery, Washington, DC, USA, 2MedStar Georgetown University Hospital Department of Breast Surgery, Washington, DC, USA.
PURPOSE:Implant-based breast reconstruction (IBR) is a valuable procedure for those undergoing oncologic mastectomy. Antimicrobial irrigation solutions are a widely practiced method to reduce infection and capsular contracture following mastectomy in IBR. This study compares the postoperative outcomes between a triple antibiotic solution (TAS) and a 0.05% chlorhexidine gluconate solution (CHG) in IBR.
METHODS:A multi-institutional retrospective cohort study was conducted, reviewing 304 breast reconstructions in 171 patients between April 2020 and July 2024. Patients were divided into two groups based on the use of TAS or CHG for both implant and breast pocket irrigation. Postoperative complications were assessed at ≤30 and ≥60 days.
RESULTS:Of the 304 breast reconstructions, TAS was used in 249 breasts and CHG in 55 breasts. There were no statistically significant differences between the TAS and CHG groups in <30-day complications such as seroma [1 (0.4%) vs. 0 (0%), p=0.82], surgical site infection [2 (0.8%) vs. 0 (0%), p=0.67], or unplanned return to the operating room [16 (6.4%) vs. 2 (3.6%), p=0.34]. Similarly, no significant differences were observed between TAS and CHG groups in ≥60-day outcomes, including capsular contracture [5 (2%) vs. 2 (3.6%), p=0.37].
CONCLUSION:Routine antimicrobial irrigation continue to be used as effective infection prophylaxis in IBR. There was no significant difference in triple antibiotic solution and chlorhexidine-based solutions in rates of short- and long-term post-operative infection, capsular contracture, and return to the operating room. Further prospective studies are warranted to establish optimal irrigation protocols and irrigation-type cost-benefit analysis in reconstructive breast surgery.
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