Prophylactic Antibiotics for Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Comparison between Three Different Duration Approaches

Abstract

Background: There is no consensus on the duration of prophylactic antibiotic use for autologous breast reconstruction after mastectomy. We attempted to standardize the use of prophylactic antibiotics after mastectomy using a deep inferior epigastric perforator flap for the breast reconstruction procedure. Methods: This retrospective case series included 108 patients who underwent immediate breast reconstruction with a deep inferior epigastric perforator flap at the Ditmanson Medical Foundation Chia-Yi Christian Hospital between 2012 and 2019. Patients were divided into three groups based on the duration of prophylactic antibiotic administration (1, 3, and >7 days) for patients with drains. Data were analyzed between January and April 2021. Results: The prevalence of surgical site infection in the breast was 0.93% (1/108), and in the abdomen it was 0%. The patient groups did not differ by age, body mass index, smoking status, or neoadjuvant chemotherapy. Only one patient experienced surgical site infection in the breast after half-deep necrosis of the inferior epigastric perforator flap. There were no significant differences in surgical site infection based on the duration of prophylactic antibiotic use. The operation time, methods of breast surgery, volume of fluid drainage in the first 3 days of the abdominal and breast drains, and day of removal of the abdominal and breast drains did not affect surgical site infection. Conclusion:Based on these data, we do not recommend extending prophylactic antibiotics beyond 24 hours in deep inferior epigastric perforator reconstruction.

The Duration of Postoperative Antibiotics in Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis

“…The location of reported SSIs within the studies analysed is generally insufficient. Liu et al reported a total of 44 (17.1%) SSIs which had an even distribution between the donor site and recipient site, Changchien et al reported a single SSI (1.2%) which affected the recipient site, and Drury et al did not mention the site in which SSIs occurred [11][12][13]. Liu et al showed insignificant differences in terms of SSI rates for the prolonged antibiotic duration with subgroup analyses including obesity, smoking, and age [12].…”

“…Changchien et al [11] Changchien et al conducted a cohort study comprising 108 patients undergoing breast reconstruction with a DIEP flap. Patients were divided into three groups based on the duration of antibiotic prophylaxis (one, three, and more than seven days), and the occurrence of SSIs was identified in each group and compared.…”