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Predictors Of Infection In Mastectomy Flap Erythema Following Mastectomy With Immediate Tissue Expander Reconstruction
Priya Chhikara, MD1, Steven Bonawitz, MD, FACS2, John Gaughan, MS, PhD, MBA3.
1Mercy Catholic Medical Center, Philadelphia, PA, USA, 2Cooper University Hospital, Camden, NJ, USA, 3Cooper Research Institute, Camden, NJ, USA.

PURPOSE: Erythema is an objective sign of inflammation, with several etiologies implicated besides infectious processes. In breast cancer patients undergoing immediate breast reconstruction with tissue expanders (TE) following mastectomy who present with post-operative erythema, a combination of documentable signs may correlate with infection as defined by the Centers for Disease Control guidelines for surgical site infection in the presence of implants. This study describes markers of TE infection in patients with erythema following immediate TE reconstruction after mastectomy and aims to provide guidance in differentiating erythema from inflammatory versus infectious causes.
METHODS: Patients who underwent mastectomy with immediate TE reconstruction between 1/1/2014-12/31/2016 and developed erythema within twelve months were identified. Infection was identified by drainage or aspirate cultures. Analyzed variables included fever (temperature >38.0 Celsius (F)), elevated white blood count (WBC), drainage or wound dehiscence (DD), and localized pain (P). Univariate analyses were performed for these variables alone and in combination using Fischer's exact test.
RESULTS: 39 patients were identified as having mastectomy flap erythema, of which 18 had documented infection. The variables and combinations determined to be statistically significant in correlating with infection are included in Table 1.
CONCLUSION: There are multiple combinations of markers associated with erythema related to infection. These can be incorporated into practice for better delineating which patients require further treatment or surgery following mastectomy with TE reconstruction.

Predictors of TE Infection
Variable(s)Odds RatioConfidence Intervalp Value
P5.51.96-36.790.0038
P/F404.28-373.75<0.0001
P/DD190.439.16-3958.33<0.0001
F/DD65.933.45-1260.86<0.0001
P/WBC6.51.6-26.360.01
P/F/WBC8.321.97-35.10.0039
P/WBC/DD5.51.22-24.810.0428
P/F/DD190.439.16-3958.33<0.0001
P/F/WBC/DD5.51.22-24.810.0428


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