Four Common Anatomic Variants that Predispose to Unfavorable Rhinoplasty Results: A Study Based on 150 Consecutive Secondary Rhinoplasties

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 degrees C for 48 hours. Povidone-iodine 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 acnes, 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.

Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets

“…3 This line of reasoning has lead to a widespread practice of in situ antibiotic irrigation of the implant pocket with a triple antibiotic solution on the basis of several observational studies. 3,13,16 Unfortunately, several studies indicate that prophylactic use of antibiotics may lead to an increased risk of acquiring iatrogenic antibiotic-resistant bacterial infections. 17–19 …”

“…3,13,16 No controlled cohort or randomized controlled studies existed demonstrating that in situ antibiotics are more or less effective at reducing the rate of capsular contracture than irrigation with sterile saline alone.…”

“…The implant pocket was created using the surgical procedure as described by Adams et al 13 The sterile sizing implant was inserted using “No-touch Technique” via a Keller Funnel. The same procedure was repeated for the contralateral breast.…”

“…3,13 Available data supporting the instillation of a triple antibiotic solution into the implant pocket are generated from observational or cross-sectional studies without directly comparing this method of pocket preparation with other methods to ascertain the effect that in situ antibiotics have in reducing the rate of capsular contracture. Frequently cited publications regarding the instillation of triple antibiotic solution to reduce capsular contracture do not control for several confounding factors, include outcomes from Food and Drug Administration-banned solution using povidone-iodine, and use a highly heterogeneous population.…”

“…Frequently cited publications regarding the instillation of triple antibiotic solution to reduce capsular contracture do not control for several confounding factors, include outcomes from Food and Drug Administration-banned solution using povidone-iodine, and use a highly heterogeneous population. 3,13 …”