Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast Reconstruction
Background:. Acellular dermal matrix (ADM) in direct-to-implant breast cancer reconstruction is the standard of care due to superior cosmetic results and decreased capsular contracture, but can be cost prohibitive. Although more economical, using patient’s own dermis (“Autoderm”) instead of ADM has...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2020-07-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002968 |
| _version_ | 1830430679315251200 |
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| author | Julian Diaz-Abele, MD Adam Padalko, BSc Kimberly Dalke, MSc Michal Brichacek, MD Edward W. Buchel, MD |
| author_facet | Julian Diaz-Abele, MD Adam Padalko, BSc Kimberly Dalke, MSc Michal Brichacek, MD Edward W. Buchel, MD |
| author_sort | Julian Diaz-Abele, MD |
| collection | DOAJ |
| description | Background:. Acellular dermal matrix (ADM) in direct-to-implant breast cancer reconstruction is the standard of care due to superior cosmetic results and decreased capsular contracture, but can be cost prohibitive. Although more economical, using patient’s own dermis (“Autoderm”) instead of ADM has undescribed sterility. Sterility is essential, as bacterial contamination may cause infection and capsular contraction. This study aimed to determine the sterility and optimal decontamination protocol of Autoderm.
Methods:. A prospective controlled study of 140 samples from 20 DIEP (deep inferior epigastric perforator) breast cancer reconstruction patients was performed. Seven de-epithelialized dermal samples (2 × 1 cm) per patient were collected from excess abdominal tissue (6 decontamination protocols and one control). Samples were submerged in povidone-iodine, chlorhexidine, or cefazolin/tobramycin/bacitracin for 15 minutes; half of the samples were agitated (150 rpm) for 15 minutes, and half were not. The control was normal saline without agitation. The solution was removed, and the tissue was sent for aerobic colony count cultures. Patient’s demographic data and complications were also collected.
Results:. Of 140 samples, 3 of 20 non-agitated povidone-iodine and 1 of 20 control samples had aerobic bacterial growth. All of the other 100 samples from 5 experimental groups (povidone-iodine + agitation, chlorhexidine ± agitation, and cefazolin/tobramycin/bacitracin ± agitation) had no aerobic bacterial growth.
Conclusions:. This study suggests povidone-iodine + agitation, chlorhexidine ± agitation, and cefazolin/tobramycin/bacitracin ± agitation are effective at sterilizing de-epithelialized dermis, whereas povidone-iodine without agitation and saline are ineffective. Autoderm with the appropriate decontamination protocol may be a potential sterile alternative to ADM. |
| first_indexed | 2024-12-21T01:54:21Z |
| format | Article |
| id | doaj.art-0c76075fd44e494999da4e01d1aae6d9 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-21T01:54:21Z |
| publishDate | 2020-07-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-0c76075fd44e494999da4e01d1aae6d92022-12-21T19:19:49ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742020-07-0187e296810.1097/GOX.0000000000002968202007000-00007Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast ReconstructionJulian Diaz-Abele, MD0Adam Padalko, BSc1Kimberly Dalke, MSc2Michal Brichacek, MD3Edward W. Buchel, MD4From the *Division of Plastic and Reconstructive Surgery, University of Manitoba, Winnipeg, Manitoba, Canada†Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.From the *Division of Plastic and Reconstructive Surgery, University of Manitoba, Winnipeg, Manitoba, CanadaFrom the *Division of Plastic and Reconstructive Surgery, University of Manitoba, Winnipeg, Manitoba, CanadaFrom the *Division of Plastic and Reconstructive Surgery, University of Manitoba, Winnipeg, Manitoba, CanadaBackground:. Acellular dermal matrix (ADM) in direct-to-implant breast cancer reconstruction is the standard of care due to superior cosmetic results and decreased capsular contracture, but can be cost prohibitive. Although more economical, using patient’s own dermis (“Autoderm”) instead of ADM has undescribed sterility. Sterility is essential, as bacterial contamination may cause infection and capsular contraction. This study aimed to determine the sterility and optimal decontamination protocol of Autoderm. Methods:. A prospective controlled study of 140 samples from 20 DIEP (deep inferior epigastric perforator) breast cancer reconstruction patients was performed. Seven de-epithelialized dermal samples (2 × 1 cm) per patient were collected from excess abdominal tissue (6 decontamination protocols and one control). Samples were submerged in povidone-iodine, chlorhexidine, or cefazolin/tobramycin/bacitracin for 15 minutes; half of the samples were agitated (150 rpm) for 15 minutes, and half were not. The control was normal saline without agitation. The solution was removed, and the tissue was sent for aerobic colony count cultures. Patient’s demographic data and complications were also collected. Results:. Of 140 samples, 3 of 20 non-agitated povidone-iodine and 1 of 20 control samples had aerobic bacterial growth. All of the other 100 samples from 5 experimental groups (povidone-iodine + agitation, chlorhexidine ± agitation, and cefazolin/tobramycin/bacitracin ± agitation) had no aerobic bacterial growth. Conclusions:. This study suggests povidone-iodine + agitation, chlorhexidine ± agitation, and cefazolin/tobramycin/bacitracin ± agitation are effective at sterilizing de-epithelialized dermis, whereas povidone-iodine without agitation and saline are ineffective. Autoderm with the appropriate decontamination protocol may be a potential sterile alternative to ADM.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002968 |
| spellingShingle | Julian Diaz-Abele, MD Adam Padalko, BSc Kimberly Dalke, MSc Michal Brichacek, MD Edward W. Buchel, MD Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast Reconstruction Plastic and Reconstructive Surgery, Global Open |
| title | Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast Reconstruction |
| title_full | Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast Reconstruction |
| title_fullStr | Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast Reconstruction |
| title_full_unstemmed | Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast Reconstruction |
| title_short | Intraoperative Autoderm Decontamination for Use in Immediate Single-stage Direct-to-implant Breast Reconstruction |
| title_sort | intraoperative autoderm decontamination for use in immediate single stage direct to implant breast reconstruction |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000002968 |
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