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Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care.

Publication ,  Conference
Phillips, BT; Wang, ED; Mirrer, J; Lanier, ST; Khan, SU; Dagum, AB; Bui, DT
Published in: Ann Plast Surg
May 2011

BACKGROUND: Despite their widespread use, there are no evidence-based guidelines on the management of closed-suction drains or antibiotics in postmastectomy breast reconstruction. The purpose of this study was to assess consensus and variation in postoperative care among plastic surgeons. METHODS: The authors designed and administered a self-reported, anonymous survey to 4669 American Society of Plastic Surgeons and Canadian Society of Plastic Surgeons members in October 2009. RESULTS: A total of 650 completed surveys were available for analysis. A majority (>81%) of respondents reported using closed-suction drains in breast reconstruction. Most surgeons (>93%) used a volume criteria for drain removal, most commonly when drain output was ≤30 mL over 24 hours (>86%). Preoperative antibiotic use was nearly universal (98%), usually consisting of intravenous cefazolin (97%). Postoperative care demonstrated less uniformity with outpatient antibiotics administered by 72% of respondents. Surgeons were divided on when to discontinue outpatient antibiotics: 46% preferred concomitant discontinuation with drains, whereas 52% preferred a specific postoperative day. No clear consensus was observed for the number (1 or 2) or type (Jackson-Pratt or Blake) of drains used. Respondents were further divided on the restriction of postoperative showering with drains and the use of acellular dermal matrix. CONCLUSIONS: These results demonstrate a consensus for drain use, drain removal, and preoperative antibiotic administration. There was no consensus for number or type of drain used, postoperative antibiotic use, shower restrictions, and use of acellular dermal matrix. Our results further emphasize the need for evidence-based postoperative-care guidelines specific to breast reconstruction.

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Published In

Ann Plast Surg

DOI

EISSN

1536-3708

Publication Date

May 2011

Volume

66

Issue

5

Start / End Page

460 / 465

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surveys and Questionnaires
  • Surgical Wound Infection
  • Surgery, Plastic
  • Surgery
  • Suction
  • Societies, Medical
  • Risk Assessment
  • Practice Patterns, Physicians'
 

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Phillips, B. T., Wang, E. D., Mirrer, J., Lanier, S. T., Khan, S. U., Dagum, A. B., & Bui, D. T. (2011). Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care. In Ann Plast Surg (Vol. 66, pp. 460–465). United States. https://doi.org/10.1097/SAP.0b013e31820c0593
Phillips, Brett T., Eric D. Wang, Joshua Mirrer, Steven T. Lanier, Sami U. Khan, Alexander B. Dagum, and Duc T. Bui. “Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care.” In Ann Plast Surg, 66:460–65, 2011. https://doi.org/10.1097/SAP.0b013e31820c0593.
Phillips, Brett T., et al. “Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care.Ann Plast Surg, vol. 66, no. 5, 2011, pp. 460–65. Pubmed, doi:10.1097/SAP.0b013e31820c0593.

Published In

Ann Plast Surg

DOI

EISSN

1536-3708

Publication Date

May 2011

Volume

66

Issue

5

Start / End Page

460 / 465

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Surveys and Questionnaires
  • Surgical Wound Infection
  • Surgery, Plastic
  • Surgery
  • Suction
  • Societies, Medical
  • Risk Assessment
  • Practice Patterns, Physicians'