Optimizing breast pocket irrigation: An in vitro study and clinical implications

William P. Adams, W. Chad H Conner, Fritz E. Barton, Rod J. Rohrich

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Subclinical infections have been implicated in the etiology of capsular contracture. Intraoperatively, breast pocket irrigation with povidone-iodine or other antibiotic solutions has been popularized; however, detrimental effects on wound healing for these agents have been reported and their efficacy against common organisms found around breast implants has not been studied. The purpose of this study was to compare the in vitro efficacy of serial dilutions of povidone-iodine and two double antibiotic solutions DAB-1 (gentamicin/polymyxin B) and DAB-2 (gentamicin/cefazolin), against organisms most commonly found around breast implants. In phase I trials, serial dilutions of povidone-iodine and DAB were combined 1:1 with cultures of five common organisms found around implants. In phase II, povidone-iodine was serially diluted in DAB-1 rather than saline. In phase III, povidone-iodine was serially diluted with DAB-2. Efficacy for all phases was determined by plating the mixture onto agar plates and incubating at 37°C for 48 hours. Povidoneiodine was 100 percent effective at a dilution of 12.5% against Staphylococcus epidermidis and 25% against Staphylococcus aureus but relatively ineffective against Escherichia coli and Pseudomonas; DAB-1 was found to be ineffective against S. epidermidis but effective against S. aureus, Propionibacterium aches, E. coli, and Pseudomonas. In phase II trials, a concentration of 12.5% povidone-iodine in DAB was effective at killing all experimental bacteria. In phase III trials, 10% povidone-iodine in DAB-2 was effective at killing all bacteria tested. In conclusion, to maximize bacterial control of common breast implant organisms and to minimize the detrimental effects on wound healing, 10% povidone-iodine in gentamycin/cefazolin may be used with excellent results and its use clinically may reduce the incidence of capsular contracture.

Original languageEnglish (US)
Pages (from-to)334-338
Number of pages5
JournalPlastic and Reconstructive Surgery
Volume105
Issue number1
StatePublished - Jan 2000

Fingerprint

Povidone-Iodine
Breast
Breast Implants
Cefazolin
Staphylococcus epidermidis
Contracture
Pseudomonas
Gentamicins
Wound Healing
Staphylococcus aureus
Polymyxins
Propionibacterium
Escherichia coli
Anti-Bacterial Agents
Bacteria
Asymptomatic Infections
In Vitro Techniques
Clinical Studies
Agar
Pain

ASJC Scopus subject areas

  • Surgery

Cite this

Optimizing breast pocket irrigation : An in vitro study and clinical implications. / Adams, William P.; Conner, W. Chad H; Barton, Fritz E.; Rohrich, Rod J.

In: Plastic and Reconstructive Surgery, Vol. 105, No. 1, 01.2000, p. 334-338.

Research output: Contribution to journalArticle

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abstract = "Subclinical infections have been implicated in the etiology of capsular contracture. Intraoperatively, breast pocket irrigation with povidone-iodine or other antibiotic solutions has been popularized; however, detrimental effects on wound healing for these agents have been reported and their efficacy against common organisms found around breast implants has not been studied. The purpose of this study was to compare the in vitro efficacy of serial dilutions of povidone-iodine and two double antibiotic solutions DAB-1 (gentamicin/polymyxin B) and DAB-2 (gentamicin/cefazolin), against organisms most commonly found around breast implants. In phase I trials, serial dilutions of povidone-iodine and DAB were combined 1:1 with cultures of five common organisms found around implants. In phase II, povidone-iodine was serially diluted in DAB-1 rather than saline. In phase III, povidone-iodine was serially diluted with DAB-2. Efficacy for all phases was determined by plating the mixture onto agar plates and incubating at 37°C for 48 hours. Povidoneiodine was 100 percent effective at a dilution of 12.5{\%} against Staphylococcus epidermidis and 25{\%} against Staphylococcus aureus but relatively ineffective against Escherichia coli and Pseudomonas; DAB-1 was found to be ineffective against S. epidermidis but effective against S. aureus, Propionibacterium aches, E. coli, and Pseudomonas. In phase II trials, a concentration of 12.5{\%} povidone-iodine in DAB was effective at killing all experimental bacteria. In phase III trials, 10{\%} povidone-iodine in DAB-2 was effective at killing all bacteria tested. In conclusion, to maximize bacterial control of common breast implant organisms and to minimize the detrimental effects on wound healing, 10{\%} povidone-iodine in gentamycin/cefazolin may be used with excellent results and its use clinically may reduce the incidence of capsular contracture.",
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