Decreasing expander breast infection: A new drain care protocol
JD Murray | ET Elwood | GE Jones | R Barrick | J Feng
BACKGROUND: Risk factors for expander reconstruction infection are
well known. However, drain use as a risk factor for the development of
infection is unclear.
OBJECTIVE: To review a simple method for drain use to help reduce
rates of infection in expander breast reconstruction.
METHODS: Two hundred consecutive single-surgeon (JDM) immediate
first-stage expander breast reconstructions were retrospectively reviewed.
The records were reviewed for history and physical examination, intraoperative
technique, perioperative management, adjuvant therapy, and
outcome with respect to expander infection necessitating premature
explantation within the first eight weeks. Infection was defined on clinical
basis, with or without culture positivity. All expanders (Mentor, USA)
were the same model (textured, port-integrated and biodimensional). Two
consecutive series of reconstructions were then created. The first series
included 177 reconstructions while the second series included 23 reconstructions.
Unlike the first series, the second series introduced a protocol in
which all reconstructions received mupirocin 2% cream to the drain sites
and all drains were removed at the end of the first week. Additionally, in
the second series, all expanders were secluded from direct in vivo contact
with the closed suction drain either by the use of an intervening Alloderm
sling (LifeCell Corporation, USA, 15 of 23 breasts) or by subdermally tunnelling
the drain superficial to an adequate fatty subcutaneous layer (eight
of 23 breasts).
RESULTS: Patients who developed infection in the first series and all
patients in the second series shared statistically the same level of aggregate
risk factors (P=0.531). The infection rate (5.65%, 10 infections in
177 breasts) in the first series was statistically greater than in the second
series (0%, 0 in 23 breasts, P=0.001).
CONCLUSIONS: The present study found that percutaneous closed suction
drains do serve as an increased risk for expander infection. However,
early results indicate that in vivo protection of the expander with Alloderm
or subdermal tunnelling, topical antibiotic ointment use and early drain
removal may significantly reduce expander infection.