Implant-Based Breast Reconstruction Outcomes Using Oxychlorosene for Pocket Irrigation

Dawson, Steven; Bamba, Ravinder; Tran, Phu C.; Mailey, Brian; Lin, Ji; Lester, Mary; Sinha, Mithun; Hassanein, Aladdin H.

doi:10.1097/prs.0000000000008271

Cited by 4 publications

(6 citation statements)

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“…In vitro results suggest that Betadine may be used in conjunction with TAB to enhance TAB efficacy if the pocket is treated for at least 5 min [ 78 , 79 ]. Other studies propose that hypochlorous acid or derivatives are efficacious in antimicrobial activity during antiseptic breast irrigation [ 77 , 84 ]. While this antiseptic is widely used in other surgical procedures, data is limited on the efficacy of hypochlorous acid in breast reconstruction.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

The Role of Microorganisms in the Development of Breast Implant-Associated Anaplastic Large Cell Lymphoma

et al. 2023

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Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a variant of anaplastic large cell lymphoma (ALCL) associated with textured-surface silicone breast implants. Since first being described in 1997, over 1100 cases have been currently reported worldwide. A causal relationship between BIA-ALCL and textured implants has been established in epidemiological studies, but a multifactorial process is likely to be involved in the pathogenesis of BIA-ALCL. However, pathophysiologic mechanisms remain unclear. One of the hypotheses that could explain the link between textured implants and BIA-ALCL consists in the greater tendency of bacterial biofilm in colonizing the surface of textured implants compared to smooth implants, and the resulting chronic inflammation which, in predisposed individuals, may lead to tumorigenesis. This review summarizes the existing evidence on the role of micro-organisms and rough surface implants in the development of BIA-ALCL. It also provides insights into the most updated clinical practice knowledge about BIA-ALCL, from clinical presentation and investigation to treatment and outcomes.

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Section: Implications For Clinical Practicementioning

confidence: 99%

The Role of Microorganisms in the Development of Breast Implant-Associated Anaplastic Large Cell Lymphoma

et al. 2023

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“…3,4 Strategies to reduce the risk of infection include antibiotic irrigation and “no-touch” technique during implant delivery. 5–9 A prolonged course of systemic, oral antibiotics has not shown evidence-based benefit. 10,11…”

Section: Local Prophylactic Antibiotics For Implant Reconstructionmentioning

confidence: 99%

“…3,4 Strategies to reduce the risk of infection include antibiotic irrigation and "no-touch" technique during implant delivery. [5][6][7][8][9] A prolonged course of systemic, oral antibiotics has not shown evidence-based benefit. 10,11 Selective, prophylactic, local delivery of antibiotics may provide the therapeutic effect of antibiotics while avoiding systemic side effects and other issues of antibiotic overuse.…”

mentioning

confidence: 99%

Prophylactic Absorbable Antibiotic Beads for High-risk, Implant-based Prepectoral Reconstruction

Ahmed,

Lee,

Roth

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Infections are problematic in postmastectomy implant-based reconstruction with infection rates as high as 30%. Strategies to reduce the risk of infection have demonstrated various efficacies. A prolonged course of systemic, oral antibiotics has not shown evidence-based benefit. Although absorbable antibiotic beads have been described for orthopedic procedures and pressure wounds, their use has not been well studied during breast reconstruction, particularly for prepectoral implant placement. The purpose of this study was to evaluate the selective use of prophylactic absorbable calcium sulfate antibiotic beads during high-risk implant-based, prepectoral breast reconstruction after mastectomy. Patients who underwent implant-based, prepectoral breast reconstruction between 2019 and 2022 were reviewed. Groups were divided into those who received antibiotic beads and those who did not. Outcome variables included postoperative infection at 90 days. A total of 148 patients (256 implants) were included: 15 patients (31 implants) who received biodegradable antibiotic beads and 133 patients (225 implants) in the control group. Patients who received antibiotic beads were more likely to have a history of infection (66.7%) compared with the control group (0%) (P < 0.01). Surgical site infection occurred in 3.2% of implants in the antibiotic bead group compared with 7.6%, but this did not reach statistical significance. The incidence of infection in high-risk patients who have absorbable antibiotic beads placed during the time of reconstruction seems to be normalized to the control group in this pilot study. We present a novel use of prophylactic absorbable antibiotic beads in prepectoral breast implant reconstruction.

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“…25 Our institution has commonly used oxychlorosene irrigation for implant-based breast reconstruction because of low cost and ease of use. 23 Comparative studies between surgical irrigation solutions are needed. The purpose of this study was to compare triple antibiotic and oxychlorosene surgical irrigation for implant-based breast reconstruction.…”

Section: Original Articlementioning

confidence: 99%

“…Oxychlorosene sodium (Clorpactin WCS-90, United Guardian, Hauppauge, N.Y.) has been used historically as an antiseptic, but there are limited data for breast implant surgery. 23 It is a derivative of hypochlorous acid and is a powerful bactericidal, fungicidal, and virucidal. 24 A recent survey of American Society of Plastic Surgeons members showed that 14% of responders used oxychlorosene for breast implant irrigation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Breast Reconstruction Outcomes Using Oxychlorosene versus Triple Antibiotic Solution for Pocket Irrigation

Bamba

Tran

Mailey

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Breast pocket irrigation with antiseptic solutions is performed to reduce contamination with breast implants. The optimal antiseptic irrigation solution and the efficacy of individual practices are unclear. Oxychlorosene sodium is frequently used at our institution. Oxychlorosene is bactericidal with a mechanism of action of oxidation and hypochlorination. The purpose of our study was to compare the outcomes of oxychlorosene sodium irrigation with triple antibiotic solution (TAS) in implant-based breast reconstruction. Methods: All patients who underwent implant-based reconstruction after mastectomy were reviewed. The primary predictive variable was type of solution used for pocket irrigation (TAS or oxychlorosene). Outcome variables included surgical site infection, device removal, and wound complications. Results: Between 2013 and 2018, 331 implant-based breast reconstructions were performed. Of these, 62% (n = 206) received oxychlorosene for surgical pocket irrigation (group I), and 38% (n = 125) received TAS (group II). Group I had an 11.7% (n = 24) 90-day surgical site infection rate, with 4.9% (n = 10) requiring oral antibiotics, 2.4% (n = 5) requiring intravenous antibiotics without device removal, and 4.4% (n = 9) requiring prosthetic removal. Group II had an 11.2% (n = 14) 90-day infection rate, with 5.6% (n = 7) requiring oral antibiotics, 2.4% (n = 3) requiring intravenous antibiotics without device removal, and 3.2% (n = 4) requiring removal (P = 0.90). When comparing the cost of oxychlorosene irrigation with TAS irrigation, oxychlorosene was less expensive. Conclusions: Oxychlorosene and TAS have similar surgical site infection rates in prosthetic breast reconstruction. Ease of preparation and cost make oxychlorosene a more favorable option for antibiotic irrigation in reconstructive breast surgery with prosthetic devices.

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Implant-Based Breast Reconstruction Outcomes Using Oxychlorosene for Pocket Irrigation

Cited by 4 publications

References 4 publications

The Role of Microorganisms in the Development of Breast Implant-Associated Anaplastic Large Cell Lymphoma

The Role of Microorganisms in the Development of Breast Implant-Associated Anaplastic Large Cell Lymphoma

Prophylactic Absorbable Antibiotic Beads for High-risk, Implant-based Prepectoral Reconstruction

Comparison of Breast Reconstruction Outcomes Using Oxychlorosene versus Triple Antibiotic Solution for Pocket Irrigation

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