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Infection Prevention Protocol in Immediate Breast Reconstruction with Tissue Expanders
Mona Adeli
Susan Vasko, MD
Ohio Health
2012-02-15
Presenter: Mona Adeli
Affidavit:
All of the work represents the original work of the medical student.
Director Name: Susan Vasko
Author Category: Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
How does this presentation meet the established conference educational objectives?
This presentation addresses complications, specifically infection rates, in breast reconstruction patients. It provides an infection prevention protocol that may lower the rates of infection, and ultimately improve the care of patients undergoing immediate breast reconstruction with tissue expanders.
How will your presentation be used by practicing physicians in the audience?
Little evidence based medicine exists regarding infection prevention protocol for immediate breast reconstruction with tissue expanders. Physicians in the audience who perform this procedure can compare the proposed protocol in our presentation to their protocols, and consequently adopt practices that may lower infection rates in their patients.
Background: Significant research has been conducted to determine the patient factors that influence infection rates in immediate breast reconstruction with tissue expanders. It has been suggested that age, BMI, use of tobacco, diagnosis with diabetes mellitus, neoadjuvent chemotherapy, axillary lymph node dissection, and post-surgical radiation therapy are risk factors for infection of the tissue expanders (Halvorson et al., 2007). However, little research exists regarding the plastic surgeon's role in the operating room in preventing infection. The purpose of this study was to examine the infection prevention protocols (protocols 1 through 4) of four plastic surgeons in their performances of immediate breast reconstruction with tissue expanders.
Methods: A retrospective analysis identified 500 immediate breast reconstructions in 301 women between the years of 2008 and 2010 among the four physicians studied. The number of infections among these women was calculated, and a one-way analysis of variance (ANOVA) was performed to compare the number of infections between the four physicians.
Results: Analysis of our data identified that the methods followed in protocol 2 resulted in the lowest rates of infection. Protocol 2 consisted of soaking tissue expanders in Betadine, using vancomycin irrigation, placing new drapes over the patient, not reprepping, using new instruments, having assistants change gloves, and changing the Bovie and suction tips.
Conclusions: This information can be applied to standardize infection prevention protocol in immediate breast reconstruction with tissue expanders. Ultimately, by integrating this protocol into the practice of more plastic surgeons, infection rates among patients should decrease, improving surgical outcomes.
