Implant salvage in breast reconstruction with severe peri‐prosthetic infection
A number of implant salvage techniques have demonstrated high success rates in the setting of mild peri‐prosthetic infection. These techniques generally include a combination of a course of intravenous/oral antibiotics; debridement/curettage of the breast pocket with or without partial or total capsulectomy; copious lavage/washout of the breast pocket using a combination of normal saline, chlorhexidine, hydrogen peroxide, povidone‐iodine and/or antibiotic wash; implant exchange with or without implant position change; and finally, primary closure or flap coverage of the breast pocket.5 These methods, however, have demonstrated lower success rates with severe peri‐prosthetic infection.10 Furthermore, certain characteristics of infection such as less common pathogens on wound culture (for example, gram‐negative rods), concurrent infection with exposure or threatened exposure of the breast prosthesis and/or the presence of frank pus with liquefied capsular tissue on exploration or severe inflammatory rind have been listed as contraindications to attempting salvage.5
A case report by Kendrick and Chase 2008, however, demonstrated successful implant salvage in a patient with severe peri‐prosthetic infection involving methicillin‐resistant Staphylococcus aureus (MRSA) utilizing negative pressure wound therapy (NPWT).14 There has been relatively little description and investigation of the use of NPWT in achieving implant salvage. To the authors' knowledge, there have been three case reports.14 These cases have included peri‐prosthetic infection following augmentation as well as breast reconstruction. All three reports demonstrated success, with the advantage of not only treatment of the infected breast pocket, but also maintenance of breast shape without evidence of capsular contracture on follow‐up.14 A novel wound therapy that combines NPWT with instillation (NPWTi) may be an important addition to existing implant salvage methods in the setting of severe peri‐prosthetic infection. This study will present the experience of the authors with an implant salvage protocol, which uses NPWTi, for patients with severe peri‐prosthetic infection following breast reconstruction.