title: Does the use of biopatch devices at drain sites reduce perioperative infectious complications in patients undergoing immediate tissue expander breast reconstruction?
abstract: BACKGROUND
  To decrease the rate of infectious complications, surgeons have begun to use Biopatch (Ethicon, Somerville, N.J.) disks at drain exit sites. The authors investigated whether use of a Biopatch disk could convey a reduction in perioperative infections in patients undergoing immediate tissue expander breast reconstruction.
  
  
  METHODS
  A retrospective review was conducted of all patients undergoing tissue expander/implant breast reconstruction from November of 2010 to November of 2012 at a single institution. Breasts were divided into two cohorts: controls with traditional adhesive dressings and those with Biopatch disks at drain sites. Breasts were compared based on demographics, complications, drain duration, and antibiotic type.
  
  
  RESULTS
  A total of 1211 breasts met inclusion criteria. The control group (November of 2010 to October of 2011) included 606 breasts. The Biopatch cohort (November of 2011 to October of 2012) included 605 breasts. When comparing breasts with disks to controls, there were no statistical differences in overall infection (6.2 versus 7.4 percent; p = 0.4235), major infection (4.0 versus 4.3 percent; p = 0.8853), need for explantation (2.2 versus 1.8 percent; p = 0.5372), and mastectomy skin flap necrosis (12.6 versus 14.6 percent; p = 0.3148). However, age greater than 50 years, diabetes mellitus, hypertension, hypercholesterolemia, obesity, history of prior breast irradiation, and mastectomy skin flap necrosis were independent predictors of infectious complications.
  
  
  CONCLUSIONS
  Biopatch disks do not reduce the rate infectious complications in patients undergoing immediate tissue expander breast reconstruction. Other conventional risks, including medical comorbidities, obesity, and mastectomy skin flap necrosis, remain significantly associated with infectious complications.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: New York, N.Y. From Memorial Sloan Kettering Cancer Center; and New York University Medical Center Institute of Reconstructive Plastic Surgery.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Clavin
authors.forename: Helen C
authors.initials: HC
authors.lastname: Miller
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001458:Bandages; D018427:Breast Implants; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004322:Drainage; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors; D015626:Tissue Expansion / Q000009:adverse effects*
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine