Plastic Surgery Research Council
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Presenter: Andrew D Navarrete, MD
Co-Authors: Tighe DR; Hoegh KN; Platner LC; Powers TA; Marshall TS; Tyler ME; Poore SO
University of Wisconsin

Background: Surgical site infections (SSI) continue to plague surgeons and patients alike following an array of operations. In tissue expander breast reconstruction, reported infection rates vary from 5 to 26%. Surgical drains are a purported entry site for bacteria; prophylactic antibiotics are used by many surgeons while drains remain in situ. Central venous catheter-related bloodstream infections have significantly decreased using antimicrobial dressings and catheter coatings. A similar strategy with surgical drains may reduce expander-related and other SSIs.

Methods: A bactericidal device compatible with standard size surgical drains was designed, consisting of platinum-cured silicone housing for concentric open cell polyurethane foam rings pretreated with chlorhexidine gluconate (CHG) and silver sulfadiazine. Six densities (23.2-92.9 kg/m3) of treated foam were tested for efficacy against Staphylococcus aureus (MSSA) under standard culture conditions. Daily for 14 days, zones of inhibition were measured and the foam transferred to freshly inoculated plates to evaluate continued release of CHG or silver. The most effective foams were further tested against common SSI-causing bacteria, methicillin-resistant S. aureus (MRSA), S. epidermidis, Streptococcus pyogenes, and Pseudomonas aeruginosa.

Results: Different foam densities optimized each impregnated agent. Optimal absorption (2.07 g/mm3) and extended release of CHG was seen in foam density 28.8 kg/m3. Silver release optimized in foam density 32.04 kg/m3. Complete inhibition of MSSA, MRSA, S. epidermidis, and S. pyogenes for 14 days was seen with CHG treated foam, with poor inhibition of P. aeruginosa. Silver treated foam completely inhibited P. aeruginosa for 14 days.

Conclusions: A bactericidal surgical drain attachment was developed utilizing chlorhexidine gluconate and silver sulfadiazine treated polyurethane foam. In-vitro microbiologic testing revealed sustained release and activity of this combination of agents against common SSI-causing bacteria for a 14 day period. This device may decrease SSIs, especially in the setting of prosthetic implants or mesh.

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