BACKGROUND:
Perioperative infectious complications associated with implant-based reconstructions continue to plague plastic surgeons. Recently, in an effort to decrease infectious complications, surgeons have begun to use Biopatch® (Ethicon: Sommerville, NJ) discs at drain exit sites. The purpose of this investigation was to determine if the use of a Biopatch® at drain exit sites could convey a reduction in perioperative infections in patients undergoing immediate tissue expander breast reconstruction.
METHODS:
After obtaining an IRB waiver, a retrospective review of all patients undergoing tissue expander/implant (TE/I) breast reconstruction from November 2010- November 2012 was conducted. Delayed reconstructions, those with additional latissimus dorsi myocutaneous flaps, and immediate permanent implants were excluded. Breasts were then divided into two cohorts: controls with traditional adhesive dressings at drain sites (year 1) and those with Biopatch® discs at drain sites (year 2). Breasts were compared based on age, body mass index (BMI), type of mastectomy, use of acellular dermal matrix (ADM), chemotherapy, radiation therapy, smoking history, medical history, tissue expander (TE) size, initial TE fill, percentage TE fill, number of drains, duration of drains, duration of antibiotics, type of antibiotic, and complications.
RESULTS:
1211 breasts met inclusion criteria, during the study period. The control group, November 2010-October 2011, included 606 breasts and the Biopatch® cohort, November 2011-October 2012, included 605 breasts. When comparing breasts with Biopatch® discs at drain sites to controls, patients were similar in age, BMI, use of acellular dermal matrix (ADM), mastectomy technique, indication for surgery, neoadjuvant chemotherapy and radiation therapy, TE size, fill, and percentage fill, medical comorbidities and smoking status. Additionally, patients had similar average duration of drains, and duration/type of antibiotics. There was no statistical difference between the control and Biopatch® cohort in overall infection (5.9% versus 7.4% (p=0.4235), major infection (4.0% versus 4.3% (=0.8853)), need for explantation (2.2% versus 1.8% (p=0.5372)) and mastectomy skin flap necrosis (12.6% versus 14.6% (p=0.3148) when compared control. Age > 50, diabetes mellitus, hypertension, hypercholesterolemia, obesity, history of prior breast irradiation, and mastectomy skin flap necrosis were found to be independent predicators of infectious complications.
CONCLUSIONS:
The use of Biopatch® discs at drain exit sites does reduce the rate infectious complication in a large series of patients undergoing immediate tissue expander breast reconstruction. Other conventional risks, including, medical comorbidities, obesity, and mastectomy skin flap necrosis remain significantly associated with infectious complications. We do not recommend Biopatch® discs at drains sites for patients undergoing immediate tissue expander breast reconstruction. Rather, additional attention should be given to approaches to decrasese risk of mastectomy skin flap necrosis and control medical comorbidities.