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Concomitant Panniculectomy Affects Wound Morbidity but Not Hernia Recurrence Rates in Abdominal Wall Reconstruction: A Propensity Score Analysis
S162
Scientific Forum Abstracts
Concomitant Panniculectomy Affects Wound Morbidity but Not Hernia Recurrence Rates in Abdominal Wall Reconstruction: A Propensity Score Analysis Salvatore Giordano, MD, PhD, Patrick B Garvey, MD, FACS, Donald P Baumann, MD, FACS, Jun Liu, MD, PhD, Charles E Butler, MD, FACS MD Anderson Cancer Center, Houston, TX INTRODUCTION: Panniculectomy (PAN) is often performed during abdominal wall reconstruction (AWR) to decrease wound healing complications and hernia recurrence rates. However, studies of AWR with concurrent panniculectomy (AWR+PAN) have reported contradictory results. We hypothesized that patients undergoing AWR+PAN experience more wound healing complications, but similar rates of hernia recurrence compared to AWR alone.
J Am Coll Surg
implantation. Doxycycline is a low-cost, widely available antibiotic with broad antimicrobial activity. Our study investigated whether impregnating silicone implants with doxycycline could prevent biofilm formation in a murine model of breast implant infection. METHODS: Pieces of silicone (50 x 50 mm) were impregnated with doxycycline using a proprietary method. Wildtype mice underwent sterile subcutaneous implantation of either doxycyclineimpregnated or vehicle-coated silicone, after which 5 x 105 CFU of E. coli in saline were directly inoculated into the wound. After 4 days, mice were sacrificed, and the implants were harvested and subjected to bath sonication to release adherent bacteria. Bacterial counts then were quantified using a plate dilution method. RESULTS: Doxycycline-impregnated silicone implants reduced bacterial colonization by 99.98% (p < 0.05, n ¼ 7) compared to vehicle-coated controls (Figure).
METHODS: In this retrospective study of 548 consecutive patients, 305 (52.5%) patients underwent AWR alone and 243 (42.4%) underwent AWR+PAN. Mean follow-up was 30 months. We compared these 2 groups’ postoperative complications and outcomes before and after propensity score analysis. The primary outcomes measures were surgical site occurrence (SSO), overall complications, surgical site infections (SSI), and hernia recurrence. RESULTS: AWR+PAN patients had a significantly higher overall complication rate (38.3% vs 29.2%, p ¼ 0.025) and a trend toward a higher SSO rate (27.6% vs 20.7%, p ¼ 0.06) compared to AWR alone. There were significantly higher incidences of skin dehiscence (19.3% vs 12.5%, p ¼ 0.032), fat necrosis (10.7% vs 3.6%, p ¼ 0.002), and infection abscess (9.5% vs 4.3%, p ¼ 0.023), but no significant difference in hernia recurrence (6.9% vs 11.5%, p ¼ 0.27) at long-term follow-up. Propensity score analysis yielded 188 pairs of matched patients, with no significant differences in overall complication and hernia recurrence rates. Significantly higher rates of fat necrosis (9.6% vs 4.3%, p ¼ 0.041) and abscess (10.1% vs 3.2%, p ¼ 0.007) were observed in the AWR+PAN group. CONCLUSIONS: AWR+PAN is associated with higher wound morbidity but similar SSO and hernia recurrence rates at longterm follow-up. We believe that panniculectomy can be safely performed when indicated. Doxycycline Impregnated Silicone Implants Are a Novel Strategy to Reduce Incidence of Breast Implant Infection Ryan M Boudreau, MD, Aaron Seitz, MD, Grace Martin, MD, Charles C Caldwell, PhD, Michael Edwards, MD, Erich Gulbins, Ryan M Gobble, MD University of Cincinnati, Cincinnati, OH, University of Duisberg-Essen, Essen, Germany INTRODUCTION: Breast implantation is frequently used for reconstruction after mastectomy. As a foreign body, these implants are at risk for infection and biofilm formation, which may lead to capsular contracture and removal of the implant. Infection remains the most common indication for readmission after
CONCLUSIONS: Breast implant infection is a significant cause of morbidity after breast reconstruction. We present a novel method for impregnating silicone implants that demonstrates marked reduction of implant biofilm in a murine model of breast implant infection. These in vivo data suggest a role for doxycycline impregnation of breast implants to mitigate the risk of implant infection and resultant capsular contracture. Doxycyline Improves Wound Healing via Nonantibiotic Associated Mechanisms Alessandra L Moore, MD, Matthew P Murphy, MB BCh BAO, MRCSI, Dre M Irizarry, MD, Elizabeth A Brett, Gerlinde Wernig, MD, PhD, Michael T Longaker, MD, MBA, FACS Stanford University, Stanford, CA INTRODUCTION: Skin scarring poses a significant problem to patients, particularly those with large incisions and injuries, due to its thickness, noncompliant texture, and reduced tensile strength. Additionally, patients who develop hypertrophic scars and keloids after healing experience pain, itching, and severe cosmetic deformity. Doxycycline is a well-known antibiotic with several other chemical properties, such as the ability to act as a mixed
Scientific Forum Abstracts
Concomitant Panniculectomy Affects Wound Morbidity but Not Hernia Recurrence Rates in Abdominal Wall Reconstruction: A Propensity Score Analysis Salvatore Giordano, MD, PhD, Patrick B Garvey, MD, FACS, Donald P Baumann, MD, FACS, Jun Liu, MD, PhD, Charles E Butler, MD, FACS MD Anderson Cancer Center, Houston, TX INTRODUCTION: Panniculectomy (PAN) is often performed during abdominal wall reconstruction (AWR) to decrease wound healing complications and hernia recurrence rates. However, studies of AWR with concurrent panniculectomy (AWR+PAN) have reported contradictory results. We hypothesized that patients undergoing AWR+PAN experience more wound healing complications, but similar rates of hernia recurrence compared to AWR alone.
J Am Coll Surg
implantation. Doxycycline is a low-cost, widely available antibiotic with broad antimicrobial activity. Our study investigated whether impregnating silicone implants with doxycycline could prevent biofilm formation in a murine model of breast implant infection. METHODS: Pieces of silicone (50 x 50 mm) were impregnated with doxycycline using a proprietary method. Wildtype mice underwent sterile subcutaneous implantation of either doxycyclineimpregnated or vehicle-coated silicone, after which 5 x 105 CFU of E. coli in saline were directly inoculated into the wound. After 4 days, mice were sacrificed, and the implants were harvested and subjected to bath sonication to release adherent bacteria. Bacterial counts then were quantified using a plate dilution method. RESULTS: Doxycycline-impregnated silicone implants reduced bacterial colonization by 99.98% (p < 0.05, n ¼ 7) compared to vehicle-coated controls (Figure).
METHODS: In this retrospective study of 548 consecutive patients, 305 (52.5%) patients underwent AWR alone and 243 (42.4%) underwent AWR+PAN. Mean follow-up was 30 months. We compared these 2 groups’ postoperative complications and outcomes before and after propensity score analysis. The primary outcomes measures were surgical site occurrence (SSO), overall complications, surgical site infections (SSI), and hernia recurrence. RESULTS: AWR+PAN patients had a significantly higher overall complication rate (38.3% vs 29.2%, p ¼ 0.025) and a trend toward a higher SSO rate (27.6% vs 20.7%, p ¼ 0.06) compared to AWR alone. There were significantly higher incidences of skin dehiscence (19.3% vs 12.5%, p ¼ 0.032), fat necrosis (10.7% vs 3.6%, p ¼ 0.002), and infection abscess (9.5% vs 4.3%, p ¼ 0.023), but no significant difference in hernia recurrence (6.9% vs 11.5%, p ¼ 0.27) at long-term follow-up. Propensity score analysis yielded 188 pairs of matched patients, with no significant differences in overall complication and hernia recurrence rates. Significantly higher rates of fat necrosis (9.6% vs 4.3%, p ¼ 0.041) and abscess (10.1% vs 3.2%, p ¼ 0.007) were observed in the AWR+PAN group. CONCLUSIONS: AWR+PAN is associated with higher wound morbidity but similar SSO and hernia recurrence rates at longterm follow-up. We believe that panniculectomy can be safely performed when indicated. Doxycycline Impregnated Silicone Implants Are a Novel Strategy to Reduce Incidence of Breast Implant Infection Ryan M Boudreau, MD, Aaron Seitz, MD, Grace Martin, MD, Charles C Caldwell, PhD, Michael Edwards, MD, Erich Gulbins, Ryan M Gobble, MD University of Cincinnati, Cincinnati, OH, University of Duisberg-Essen, Essen, Germany INTRODUCTION: Breast implantation is frequently used for reconstruction after mastectomy. As a foreign body, these implants are at risk for infection and biofilm formation, which may lead to capsular contracture and removal of the implant. Infection remains the most common indication for readmission after
CONCLUSIONS: Breast implant infection is a significant cause of morbidity after breast reconstruction. We present a novel method for impregnating silicone implants that demonstrates marked reduction of implant biofilm in a murine model of breast implant infection. These in vivo data suggest a role for doxycycline impregnation of breast implants to mitigate the risk of implant infection and resultant capsular contracture. Doxycyline Improves Wound Healing via Nonantibiotic Associated Mechanisms Alessandra L Moore, MD, Matthew P Murphy, MB BCh BAO, MRCSI, Dre M Irizarry, MD, Elizabeth A Brett, Gerlinde Wernig, MD, PhD, Michael T Longaker, MD, MBA, FACS Stanford University, Stanford, CA INTRODUCTION: Skin scarring poses a significant problem to patients, particularly those with large incisions and injuries, due to its thickness, noncompliant texture, and reduced tensile strength. Additionally, patients who develop hypertrophic scars and keloids after healing experience pain, itching, and severe cosmetic deformity. Doxycycline is a well-known antibiotic with several other chemical properties, such as the ability to act as a mixed