Background: Patients who have undergone prior chest wall irradiation can present as challenging candidates for implant reconstruction because of troublesome rates of infectious complications. The issue of antibiotic prophylaxis remains controversial, and evidence-based postoperative strategies to reduce implant infections have not been well described in the literature. The purpose of this study was to determine the efficacy of extended trimethoprim/sulfamethoxazole therapy in preventing implant infections in the irradiated chest wall.
Methods: A retrospective chart review of hospital and office records was performed on all patients undergoing implant reconstruction performed by a single surgeon (J.M.S.) from August of 2005 to March of 2008. Before 2007, the senior author used 5 to 7 days of cephalosporin prophylaxis. Subsequent to this period, the prophylactic regimen was amended to provide patients with previous chest wall irradiation prophylactic trimethoprim/sulfamethoxazole for 30 days after implant insertion.
Results: Fifty-one implant reconstructions, in the setting of prior ipsilateral chest wall irradiation, were performed. The mean follow-up time was 39 months. The infection rate for the routine cephalosporin group was 35 percent as compared with 8 percent for the extended trimethoprim/sulfamethoxazole group (p = 0.038). After multivariate analysis, extended trimethoprim/sulfamethoxazole remained the only significant factor that influenced the rate of infection (p = 0.05). The mean time to infection was 13 weeks for the routine cephalosporin group and 1.5 weeks for the extended trimethoprim/sulfamethoxazole group (p = 0.044).
Conclusion: Extended trimethoprim/sulfamethoxazole therapy demonstrates preliminary evidence as an effective adjunctive measure for reducing the rate of implant infections in breast reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
From the Division of Plastic Surgery, University of Pennsylvania Health System.
Received for publication May 16, 2011; accepted July 13, 2011.
Presented at the 90th Annual Meeting of the American Association of Plastic Surgeons, in Boca Raton, Florida, April 9 through 12, 2011; and the 56th Annual Meeting of the Plastic Surgery Research Council, in Louisville, Kentucky, April 28 through 30, 2011.
Disclosure: Dr. Serletti is a stockholder in Johnson & Johnson (Mentor Corp.). The remaining authors have no financial interests associated with this article.
Joseph M. Serletti, M.D.; Division of Plastic Surgery, University of Pennsylvania, 10 Penn Tower, 3400 Spruce Street, Philadelphia, Pa. 19104, firstname.lastname@example.org