Does the Usage of Drains Create a Risk of Surgical Site Infection During Breast Surgery?

Yıl 2023, Cilt: 33 Sayı: 5, 599 - 602, 25.10.2023

Tuğba Gün Koplay , Asuman Guzelant

https://doi.org/10.54005/geneltip.1342669

Öz

Aim: Drains are used to avoid hematoma, seroma and infection in breast surgery. A topic of debate in breast surgery research is the probability of surgical sites becoming infected through retrograde contamination. In this study, we aimed to determine whether drains cause surgical site infections by using drain tip cultures.
Material and Methods: This study included 162 breasts of 99 patients who had undergone breast surgeries, including augmentation, reduction, reconstruction and gynecomastia, with the same surgeon. Data on the patients’ demographic characteristics, clinical findings, antibiotherapies, types of surgeries and drain features, such as type, duration of use, output volume and tip cultures, were collected retrospectively.
Results: The study included 99 patients—3 male, 96 female—with a mean age of 37.84. The mean body mass index was 24.5. Seven breast augmentations, three gynecomastia surgeries, 37 breast reconstructions with implants, three breast reconstructions with latissimus dorsi flaps and 49 reduction mammoplasties were performed. We did not observe infectious symptoms, such as fever, hyperemia, abscess or hematoma, in any of the patients. Fifty-six Jackson–Pratt® drains and 106 Hemovac drain tip cultures were evaluated. The mean follow-up duration was 7.16 days, and the mean output volume was 224.66 cc. The drain tip cultures of all the patients were negative.
Conclusions: According to our analysis, drains did not cause retrograde contamination or surgical site infection.

Anahtar Kelimeler

Breast surgery, Drain, Surgical site infection

Meme Ameliyatlarında Dren Kullanımı Cerrahi Alan Enfeksiyonu Riski Oluşturur mu?

Öz

Amaç: Meme cerrahisinde hematom, seroma ve enfeksiyondan korunmak için drenler kullanılır. Drenlerden ters akım yoluyla cerrahi alanın kontamine olma olasılığı meme cerrahisinde tartışılan konulardandır. Bu çalışmada dren ucu kültürleri kullanılarak drenlerin cerrahi alan enfeksiyonuna neden olup olmadığının tespit edilmesi amaçlandı.
Gereç ve Yöntemler: Bu çalışmaya aynı cerrah tarafından opere edilen meme büyütme, meme küçültme, meme rekonstrüksiyonu ve jinekomastiyi içeren meme cerrahilerinin yapıldığı 99 hastanın 162 memesi dahil edildi. Hastalara ait demografik özellikler, klinik bulgular, antibiyoterapiler, ameliyat tipleri ve dren özellikleri (dren tipi, dren kalış süresi, toplam drenaj hacmi ve dren ucu kültür sonuçları) verileri geriye dönük olarak incelendi.
Bulgular: Çalışmaya yaş ortalaması 37.84 olan 3 erkek, 96 kadın olmak üzere 99 hasta dahil edildi. Ortalama vücut kitle indeksi 24.5 idi. Mart 2022 ve Şubat 2023 tarihleri arasında 7 meme büyütme, 3 jinekomasti, 37 implant ile meme rekonstrüksiyonu, 3 latissimus dorsi ile meme rekonbstrüksiyonu ve 49 meme küçültme cerrahisi uygulandı. Hiçbir hastada ateş, hiperemi, apse, hematom gibi enfeksiyöz semptomlara rastlamadık. 56 Jackson-Pratt® dreni ve 106 Hemovac dren ucu kültürü değerlendirildi. Ortalama takip süresi 7,16 gün, ortalama çıkış hacmi 224,66 cc idi. Tüm hastaların dren ucu kültürleri negatif olarak geldi.
Sonuç: Yapılan analizler sonucunda drenlerin geriye akım ile kontaminasyona ve cerrahi alan enfeksiyonuna neden olmadığı görüldü.

Anahtar Kelimeler

Cerrahi alan enfeksiyonu, Dren, Meme cerrahisi

Kaynakça

• Harish R, Kazi FN, Sharma JVP. Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection. Surg J (N Y). 2021;7(4):e275-e280. Murray JD, Elwood, Jones GE, Barrick R, Feng J. Decreasing expander breast infection: A new drain care protocol. Can J Plast Surg 2009;17:17-21.
• Scomacao I, Cummins A, Roan E, Duraes EFR, Djohan R. The use of surgical site drains in breast reconstruction: A systematic review. J Plast Reconstr Aesthet Surg. 2020;73:651-662.
• Kim C, Park JW, Song MG, Choi HS. Suction Drain Tip Cultures in Predicting a Surgical Site Infection. Asian Spine J. 2023;17(3):470-476.
• Pennington Z, Lubelski D, Molina C, Westbroek EM, Ahmed AK, Sciubba DM. Prolonged Post-surgical Drain Retention Increases Risk for Deep Wound Infection After Spine Surgery. World Neurosurg. 2019;130:e846-e853.
• Barbadoro P, Marmorale C, Recanatini C, et al. Drainages Collaborative Working Group. May the drain be a way in for microbes in surgical infections? Am J Infect Control. 2016;44:283-8.
• Isik O, Kaya E, Dundar HZ, Sarkut P. Surgical Site Infection: Re-assessment of the Risk Factors. Chirurgia (Bucur). 2015; 110:457-61.
• Teija-Kaisa A, Eija M, Marja S, Outi L. Risk factors for surgical site infection in breast surgery. J Clin Nurs. 2013; 22:948-57.
• Reiffel AJ, Barie PS, Spector JA. A multi-disciplinary review of the potential association between closed-suction drains and surgical site infection. Surg Infect (Larchmt). 2013 ; 14:244-69.
• Zapata-Copete J, Aguilera-Mosquera S, García-Perdomo HA. Antibiotic prophylaxis in breast reduction surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2017 ; 70:1689-1695.
• Hardwicke JT, Bechar J, Skillman JM. Are systemic antibiotics indicated in aesthetic breast surgery? A systematic review of the literature. Plast Reconstr Surg. 2013 ;131:1395-1403.
• Keramidas E, Lymperopoulos NS, Rodopoulou S. Is antibiotic prophylaxis in breast augmentation necessary? A prospective study. Plast Surg (Oakv). 2016;24:195-198.
• Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trail. Br J Plast Surg. 2005;58:286-289.
• Khan SM, Smeulders MJ, Van der Horst CM. Wound drainage after plastic and reconstructive surgery of the breast. Cochrane Database Syst Rev. 2015 ;2015(10):CD007258.
• Bascone CM, Chua C, Pereira C. Ideal Drain in Alloplastic Breast Reconstruction: Does the Number or Type of Drain Matter? Plast Reconstr Surg. ;150(5):1116e-1117e.
• Sorensen AI, Sørensen TS. Bacterial growth on suction drain tips. Prospective study of 489 clean orthopedic operations. Acta Orthop Scand. 1991;62(5):451-454.
• Chen CF, Lin SF, Hung CF, Chou P. Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction: A cohort study. Medicine (Baltimore). 2016;95(49):e5605.
• Pérez-Cameo C, Lung M, Hidalgo E, et al. Does Routine Abdominal Drain Tip Culture Anticipate Post-Operative Infection in Liver Transplantation? Surg Infect (Larchmt). 2021 ;22(2):222-226.