Trial of Drain Antisepsis After Tissue Expander Breast Reconstruction
Surgical site infection (SSI) after breast and axillary surgery occurs more often then for other clean surgical procedures. Infection in the setting of a tissue expander can be devastating and can lead to early implant loss and failed reconstruction. Surgical drains have been noted as a potential source for surgical site infections. Bacteria present in surgical drains after tissue expander reconstruction may be decreased by simple and inexpensive local antiseptic interventions.
Nonmalignant Breast Conditions
Device: sodium hypochlorite (Dakins Soln)
Drug: Chlorhexidine gluconate disk
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Factorial Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Prevention
|Official Title:||Trial of Drain Antisepsis After Tissue Expander Breast Reconstruction|
- Decrease bacterial colonization in drain fluid [ Time Frame: Up to one month. The hemovac drains will be in the subject up to one month. ] [ Designated as safety issue: No ]To determine if chlorhexidine disk application and drainage bulb irrigation with dilute Dakin's solution (buffered sodium hypochlorite solution) after tissue expander breast reconstruction effectively decreases bacterial colonization rates of drain fluid compared to standard care
|Study Start Date:||May 2011|
|Estimated Study Completion Date:||December 2013|
|Estimated Primary Completion Date:||October 2013 (Final data collection date for primary outcome measure)|
A chlorhexidine sponge (BioPatch) covered by an occlusive adhesive dressing (Tegaderm) will be applied to the intervention drain sites and changed every three days. The drainage bulb will be irrigated with 10ml of 0.125% Dakins solution twice a day.
Device: sodium hypochlorite (Dakins Soln)
10 ml of 0.125% Dakin's solution irrigation to the drainage bulb two times a day
Other Name: Dakins solutionDrug: Chlorhexidine gluconate disk
Apply one chlorhexidine disk to the intervention drain site(s) and change every three days
Other Name: BioPatch Protective Disk with CHG
|No Intervention: Control|
Surgical Site infection after breast surgical procedures occurs more frequently than for other clean surgical procedures. Considering the large numbers of patients who undergo breast-related procedures per year and the increasing use of immediate breast reconstruction with placement of tissue expanders or immediate implant reconstruction, a surgical site infection involving the implant can result in its removal and a failed reconstruction.
The primary aim of the study is to determine if chlorhexidine disk application and irrigation of the drainage bulb with dilute Dakin's solution (buffered sodium hypochlorite solution)after tissue expander breast reconstruction or immediate implant reconstruction, effectively decreases rates of bacterial colonization in drain fluid compared to standard care.
- To determine baseline rates of bacterial colonization of drain fluid and drain tubing after tissue expander breast reconstruction.
- To determine if bacterial colonization of fluid in the drain bulb correlates with bacterial colonization of internal segments of the drain catheter within the wound site.
- To determine if interventions directed at drain antisepsis are associated with reduced rates of bacterial growth from tissue expander biofilm.
Eighty-five patients undergoing bilateral immediate reconstruction with tissue expander placement will have one surgical site treated with standard drain care and the other treated with a drain antisepsis regimen. Drain antisepsis intervention will consist of two measures: 1) placement of a chlorhexidine sponge dressing at the drain exit site, and 2) twice daily irrigation of the drainage bulb with dilute Dakin's solution (buffered hypochlorite).
All patients will undergo semiquantitative cultures of the drain bulb at one week postoperatively. This culture will be repeated at the time of drain removal, with simultaneous cultures of the fluid in the bulb as well as an internal segment of each removed drainage tube. All patients will be evaluated for clinical signs of infection and for any adverse reactions to the drain antisepsis at the follow-up visits.
|United States, California|
|San Francisco, California, United States, 94107|
|United States, Minnesota|
|Rochester, Minnesota, United States, 55904|
|Principal Investigator:||Amy C Degnim, M.D.||Mayo Clinic, Rochester, MN|