Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction
Background:. Periprosthetic infections remain a major challenge for breast reconstruction. Local antibiotic delivery systems, such as antibiotic beads and spacers, have been widely used within other surgical fields, but their use within plastic surgery remains scarce. In this study, we demonstrate t...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-01-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004764 |
| _version_ | 1797894186639294464 |
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| author | Thomas Johnstone, BS Kelsey Lipman, MD Nathan Makarewicz, BA Jennifer Shah, BA Elizabeth Turner, PA-C Victoria Posternak, MS, RN Daniel Chang, MD Brian Thornton, MD Rahim Nazerali, MD, MHS, FACS |
| author_facet | Thomas Johnstone, BS Kelsey Lipman, MD Nathan Makarewicz, BA Jennifer Shah, BA Elizabeth Turner, PA-C Victoria Posternak, MS, RN Daniel Chang, MD Brian Thornton, MD Rahim Nazerali, MD, MHS, FACS |
| author_sort | Thomas Johnstone, BS |
| collection | DOAJ |
| description | Background:. Periprosthetic infections remain a major challenge for breast reconstruction. Local antibiotic delivery systems, such as antibiotic beads and spacers, have been widely used within other surgical fields, but their use within plastic surgery remains scarce. In this study, we demonstrate the use of antibiotic-impregnated polymethylmethacrylate (PMMA) plates for infection prophylaxis in tissue expander (TE)-based breast reconstruction.
Methods:. A retrospective review of patients who underwent immediate breast reconstruction with prepectoral TEs over the span of 5 years performed by two surgeons was completed, revealing a total of 447 patients. Data pertaining to patient demographics, operative details, and postoperative outcomes were recorded. Fifty patients underwent TE reconstruction with the addition of a PMMA plate (Stryker, Kalamazoo, Michigan) impregnated with tobramycin and vancomycin. Antibiotic plates were removed at the time of TE-to-implant exchange. Patient-matching analysis was performed using the 397 patients without PMMA plates to generate a 50-patient nonintervention cohort for statistical analysis.
Results:. The intervention cohort (n = 50) and 1:1 patient-matched nonintervention cohort (n = 50) demonstrated no statistically significant differences in patient demographics or operative characteristics other than PMMA plate placement. The rate of operative periprosthetic infection was 4% in the intervention group and 14% in the nonintervention group (P = 0.047). The rate of TE explantation was also reduced in the intervention group (6% versus 18%; P = 0.036). Follow-up averaged 9.1 and 8.9 months for the intervention and nonintervention groups, respectively (P = 0.255).
Conclusion:. Local antibiotic delivery using antibiotic-impregnated PMMA plates can be safely and effectively used for infection prevention with TE-based breast reconstruction. |
| first_indexed | 2024-04-10T07:04:50Z |
| format | Article |
| id | doaj.art-4de2aa0d1ddf489b869893418c0dba9d |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-10T07:04:50Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-4de2aa0d1ddf489b869893418c0dba9d2023-02-27T09:01:50ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742023-01-01111e476410.1097/GOX.0000000000004764202301000-00034Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast ReconstructionThomas Johnstone, BS0Kelsey Lipman, MD1Nathan Makarewicz, BA2Jennifer Shah, BA3Elizabeth Turner, PA-C4Victoria Posternak, MS, RN5Daniel Chang, MD6Brian Thornton, MD7Rahim Nazerali, MD, MHS, FACS8From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, Calif.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, Calif.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, Calif.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, Calif.† Thornton Plastic Surgery, Louisville, Ky.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, Calif.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, Calif.† Thornton Plastic Surgery, Louisville, Ky.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, Calif.Background:. Periprosthetic infections remain a major challenge for breast reconstruction. Local antibiotic delivery systems, such as antibiotic beads and spacers, have been widely used within other surgical fields, but their use within plastic surgery remains scarce. In this study, we demonstrate the use of antibiotic-impregnated polymethylmethacrylate (PMMA) plates for infection prophylaxis in tissue expander (TE)-based breast reconstruction. Methods:. A retrospective review of patients who underwent immediate breast reconstruction with prepectoral TEs over the span of 5 years performed by two surgeons was completed, revealing a total of 447 patients. Data pertaining to patient demographics, operative details, and postoperative outcomes were recorded. Fifty patients underwent TE reconstruction with the addition of a PMMA plate (Stryker, Kalamazoo, Michigan) impregnated with tobramycin and vancomycin. Antibiotic plates were removed at the time of TE-to-implant exchange. Patient-matching analysis was performed using the 397 patients without PMMA plates to generate a 50-patient nonintervention cohort for statistical analysis. Results:. The intervention cohort (n = 50) and 1:1 patient-matched nonintervention cohort (n = 50) demonstrated no statistically significant differences in patient demographics or operative characteristics other than PMMA plate placement. The rate of operative periprosthetic infection was 4% in the intervention group and 14% in the nonintervention group (P = 0.047). The rate of TE explantation was also reduced in the intervention group (6% versus 18%; P = 0.036). Follow-up averaged 9.1 and 8.9 months for the intervention and nonintervention groups, respectively (P = 0.255). Conclusion:. Local antibiotic delivery using antibiotic-impregnated PMMA plates can be safely and effectively used for infection prevention with TE-based breast reconstruction.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004764 |
| spellingShingle | Thomas Johnstone, BS Kelsey Lipman, MD Nathan Makarewicz, BA Jennifer Shah, BA Elizabeth Turner, PA-C Victoria Posternak, MS, RN Daniel Chang, MD Brian Thornton, MD Rahim Nazerali, MD, MHS, FACS Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction Plastic and Reconstructive Surgery, Global Open |
| title | Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction |
| title_full | Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction |
| title_fullStr | Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction |
| title_full_unstemmed | Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction |
| title_short | Use of Antibiotic-impregnated Polymethylmethacrylate (PMMA) Plates for Prevention of Periprosthetic Infection in Breast Reconstruction |
| title_sort | use of antibiotic impregnated polymethylmethacrylate pmma plates for prevention of periprosthetic infection in breast reconstruction |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004764 |
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