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Experimental Study of the Value of Topical Irrigation in Controlling Infection of Grafted Cartilage

Hu, Xiaogeng, M.D., PhD.; Ma, Haihuan, M.D., PhD.; Cui, Peng, M.D.; Xue, Zhiqiang, M.D., PhD.; Qi, Huijie, M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 458e-459e
doi: 10.1097/PRS.0b013e3181bf8340

Plastic Surgery Department China Japan Friendship Hospital under Chinese Health Ministry Beijing, People's Republic of China

Correspondence to Dr. Hu

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Infection of the grafted cartilage is not uncommon in plastic surgery. Generally speaking, three factors are indispensable in the process of infection. They are (1) the existence of more than a minimum amount of pathogen, (2) the conditions suitable for reproduction of the microorganism, and (3) a decrease of innate capacity of resistance to infection or the pathogenic toxicity far beyond the resistance of the host immune ability.1,2 Once the grafted cartilage is infected, in the past, surgeons had been inclined to take out the infected cartilage to control the infection. This renders the previous performance painfully invalidated.

To investigate whether topical irrigation of the infected cartilage could help to preserve the grafted cartilage and heal the wound, we planned our experiment and completed the study. To date, the rabbit has been widely and successfully used as an infective animal model.3 Although the condition of the infection is different from clinical infection, we found the topical infective features to be similar to clinical changes.4

In the experiment, we established a rabbit model and carried out our research. In this process, we first established a rabbit model. The rabbit rib cartilage was extracted and implanted subcutaneously in the ventral side of the ear. We then introduced a certain amount of Staphylococcus aureus into the recipient site in different stages to establish an animal model with a conditioned infection. One group of six models received a conditioned infection intraoperatively. In 18 models, we successfully established the animal model through introduction of S. aureus into the recipient sites 1 week after survival of the grafted cartilage. After successful establishment of the animal model, we irrigated the infected cartilage with mixed antibiotic/saline solution every day. To evaluate the effectiveness of the general use of antibiotic, two groups received intramuscular administration of antibiotic, whereas the remaining two groups did not. The final outcomes were analyzed statistically.

Different results of the five infected groups existed on the basis of the conditioned infection stage and the degree of management after infection. All of the intraoperatively infected grafted cartilage unavoidably necrosed. After a period of topical irrigation, the grafted cartilage survived and the infected wounds healed in all 18 rabbit models. On the contrary, the ones without topical irrigation almost necrosed whether or not they received general use of antibiotic. The results are clearly seen in Figure 1.

Fig. 1.

Fig. 1.

Xiaogeng Hu, M.D., Ph.D.

Haihuan Ma, M.D., Ph.D.

Peng Cui, M.D.

Zhiqiang Xue, M.D., Ph.D.

Huijie Qi, M.D.

Plastic Surgery Department

China Japan Friendship Hospital under Chinese Health Ministry

Beijing, People's Republic of China

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No economic support was derived in preparation of this article.

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1.Proctor RA, van Langevelde P, Kristjansson M, Maslow JN, Arbeit RD. Persistent and relapsing infections associated with small-colony variants of Staphylococcus aureus. Clin Infect Dis. 1995;20:95–102.
2.Van-Erp K, Dach K, Koch I, Heesemann J, Hoffmann R. Role of strain differences on host resistance and the transcriptional response of macrophages to infection with Yersinia enterocolitica. Physiol Genomics 2006;25:75–84.
3.Chambers HF. Evaluation of ceftobiprole in a rabbit model of aortic valve endocarditis due to methicillin-resistant and vancomycin-intermediate Staphylococcus aureus. Antimicrob Agents Chemother. 2005;49:884–888.
4.Moreillon P, Que YA, Bayer AS. Pathogenesis of streptococcal and staphylococcal endocarditis. Infect Dis Clin North Am. 2002;16:297–318.

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