Ontology type: schema:ScholarlyArticle
2018-02
AUTHORSCemile Nurdan Ozturk, Can Ozturk, Allison Soucise, Mary Platek, Nabiha Ahsan, Robert Lohman, Wong Moon, Risal Djohan
ABSTRACTINTRODUCTION: Removal of tissue expanders (TE) or implants is a dire consequence of breast reconstruction, and has the potential to halt the reconstructive efforts. Our goals were to characterize a cohort of patients with TE/implant removal, to perform a time-based analysis, and to review the bacteriology associated with explanted devices. MATERIALS AND METHODS: Review of a prospectively maintained database was performed to identify patients who underwent TE/implant removal. Patient characteristics, surgical technique, adjuvant therapies, indications, complications, culture results were obtained. Data were analyzed according to timing of explantation. RESULTS: A total of 55 TE and implants were removed in 43 patients. Reasons for explantation were infection (58%), patient request (22%), and wound-related complications (20%). The majority of explantations occurred after 30 days (62%), and after Stage I (81%). Median days to explantation was 62. Patients of older age (p = 0.01) and higher BMI (p = 0.02) were more likely to undergo explantation after Stage I. The most commonly cultured organisms were S. epidermidis (10.9%), S. aureus (10.9%) and P. aeruginosa (10.9%). Antibiotic resistance was commonly encountered for ampicillin, cefazolin, penicillin, and erythromycin. CONCLUSION: Infection is the most common reason for explantation after prosthetic breast reconstruction. Patients should be carefully monitored for a prolonged period of time after Stage I, as the majority of explantations occur in this stage but beyond 30 days. For oral treatment, fluoroquinolones and trimethoprim-sulfamethoxazole and for IV treatment a combination of vancomycin or daptomycin with piperacillin-tazobactam or imipenems/carbapenems appear to be appropriate choices according to our culture results. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . More... »
PAGES64-72
http://scigraph.springernature.com/pub.10.1007/s00266-017-1031-8
DOIhttp://dx.doi.org/10.1007/s00266-017-1031-8
DIMENSIONShttps://app.dimensions.ai/details/publication/pub.1099907469
PUBMEDhttps://www.ncbi.nlm.nih.gov/pubmed/29270693
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