Northeastern Society of Plastic Surgeons

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Wash and Learn: The Use of Low Dose Chlorhexidine Solution in Preventing Intraoperative Contamination in Tissue Expander-Based Breast Reconstruction
Anna M. Vaeth*1, Jaime L. Bernstein1, Ashley Zhang2, Makayla Kochheiser1, Nancy Qin1, Karina Condez1, Kristen Castellano1, Grant G. Black1, David Otterburn1
1Weill Cornell Medicine, New York, NY; 2Columbia University Vagelos College of Physicians and Surgeons, New York, NY

Background: While the etiology of capsular contracture remains controversial, one theory suggests that it is caused by subclinical infection and microbial biofilms. Irrisept is a low-pressure irrigation containing chlorhexidine gluconate that offers broad spectrum activity against microorganisms. Its use has been shown to decrease bacterial load in various implants. The aim of this study is to assess the ability of Irrisept to decrease intraoperative bacterial detection in tissue expander (TE)-based breast reconstruction.
Methods: This is a single surgeon study including a retrospective review of historical patients with pre-pectoral TE-based breast reconstructions and a prospective review for patients who received Irrisept. Breast pockets were irrigated with Irrisept immediately before TE placement. The TE was also soaked with Irrisept prior to placement. Cultures were taken from breast pockets during the final step before closing.
Results: The study included 70 breasts from 41 patients: 52 breasts without Irrisept irrigation and 18 breasts with Irrisept irrigation. Patients with and without Irrisept irrigation are comparable in age and BMI (48 vs 55 and 23.4 vs. 24.3, p>0.05). In breasts without Irrisept irrigation, 5 breasts had positive intraoperative cultures (9.6%). In breasts treated with Irrisept, 0 breasts had positive intraoperative cultures. Bacteria detected in breasts without Irrisept irrigation included coagulase negative Staphylococcus in 1 breast and Cutibacterium acnes in 4 breasts. Of note, there were no adverse reactions to Irrisept.
Conclusions: We are one of the first groups to study Irrisept in TE-based breast reconstruction. Although this was a pilot study with limited sample size, we have shown that Irrisept can reduce the number of bacteria detected by culture intraoperatively. This suggests that Irrisept can be used to limit contamination during TE placement. Longer follow-up is needed to elucidate how this will translate to clinical contracture.

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