Plastic Surgery Research Council

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Doxycycline-Coated Silicone Breast Implant Reduces Surgical Site Infections Compared to Standard Gentamycin/Cefazolin/Bacitracin Wash
Mitchell J. Skinner, B.S.1, Jennifer E. Baker, MD1, Ryan M. Boudreau, MD1, Aaron P. Seitz, MD1, Erich Gulbins, MD, PhD2,1, Michael J. Edwards, MD1, Ryan M. Gobble, MD1.
1University of Cincinnati, College of Medicine, Department of Surgery, Cincinnati, OH, USA, 2University of Duisburg-Essen, University Hospital Essen, Department of Molecular Biology, Cincinnati, OH, USA.

INTRODUCTION:
Infection and capsular contracture are two of the most common complications after silicone breast implantation. Approximately 0.5-30% of augmentations and reconstructions develop complications. Subclinical infections have been implicated in capsular contractures 20-60% of the time and often require reconstructive revision. We have developed a novel method of coating silicone implants with doxycycline and hypothesize a significant reduction of surgical site infections as compared to the standard antibiotic wash.
METHODS:
Pieces of silicone breast implant were coated with doxycycline or ethanol using our novel dip-coating method. Wildtype mice underwent sterile subcutaneous pocket creation and wash with either normal saline (NS) or a gentamycin/cefazolin/bacitracin (Abx) wash. Doxycycline-coated or vehicle control-dipped silicone was then inserted into the pocket and inoculated with methicillin resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa (PA). After 3 or 7 days, mice were sacrificed, and the implants were harvested and subjected to bath sonication. Bacterial counts were then quantified after 24 hours.
RESULTS:
Doxycycline-coated implants significantly reduced MRSA adherence (Figure 1) as compared to both ethanol + NS and ethanol + Abx wash (n=8, p<0.05) after 3 and 7 days. PA inoculated doxycycline-coated implants significantly reduced bacterial adherence compared to ethanol + NS wash (n=8, p<0.05), but no significant difference was seen against ethanol + Abx wash (n=8, p>0.05) after 3 and 7 days.
CONCLUSIONS:
Doxycycline-coated silicone implants significantly reduce implant bacterial colonization in a murine model compared to the standard gentamycin/cefazolin/bacitracin wash used in breast reconstruction against MRSA and was not inferior against PA.


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