Application of Closed Irrigation-Suction for Postoperative Infection Control in Plastic Surgery

Abstract

Sir: Closed irrigation-suction systems have been used successfully in the management of osteomyelitis of the long bones,1 joint infections,2 open joint injuries,3 and pancreatic necrosis.4 Plastic operations often create adequate pockets for the placement of autogenous graft or prosthesis through a small incision, such as breast augmentation, augmentation rhinoplasty, tissue expansion, and others. Once infections occur, thorough drainage is difficult to obtain, thus prolonging healing time. Traditional incision and drainage will leave unpleasant scars and need a long healing time. A total of 31 patients with infections after plastic surgical procedures were treated by closed irrigation-suction from July of 2000 to June of 2008. Eight patients who underwent expander implantation had partial incision rupture, exposure of expander, and turbid effusion. Nine patients presented with high temperature and red, tender skin superficial to the expander during the inflating period. Two patients had tenderness and brown drainage discharged from the incision 7 days after autogenous dermis-fat implantation for facial depression. Two patients developed swelling breast skin, painful mass, and white pus obtained by aspiration 7 to 10 days after breast augmentation with autofat injection. Two patients presented with redness, tenderness, swelling breast skin, and yellow turbid drainage that leaked from the incision after breast prosthetic mammary augmentation through an areola margin incision. Three patients developed tenderness of the wound with pus drainage after treatment of axillary osmidrosis by a small-incision subcision of the apocrine gland. Five patients presented with erythematous and swelling skin and pus drainage gained by aspiration after silicone prosthetic augmentation rhinoplasty. The rupture incision was enlarged a little along the primary incision. The skin margins of the wound were then excised conservatively. In breast abscesses, an incision that was most superficial to the abscess cavity was used. The nose implant was removed. The tissue expanders were removed and sterilized or replaced with new sterile implants. The pocket was irrigated with povidone-iodine solution. Two transfusion systems or infusion needle tubes were used for both inflow and outflow drainage. Then, the sterilized implant was replaced in the cavity and the wound was closed in layers. Irrigation with normal saline containing 160 mg of gentamicin per liter was initiated when the patient was brought to the nursing unit. Intravenous broad-spectrum antibiotic therapy were administered for 6 to 8 days. All cases healed within 6 to 8 days. The expanders and silicone breast implants were salvaged successfully. Augmentation rhinoplasty was performed 1 to 2 months after wound healing. The appearance and softness of the breast were satisfactory, and there were no capsule contractures at 5-year follow-up. There was no recurrent infection in the other cases during the 6- to 12-month follow-up period. No additional, visible scar was left. Continuous closed irrigation-suction was particularly suitable for postoperative infections in plastic surgery (Figs. 1 and 2).Fig. 1.: Patient presented with redness, tenderness, and swelling breast skin after breast prosthetic mammary augmentation.Fig. 2.: Patient's appearance 5 years after surgery.Zuojun Zhao, M.D. Wei Zhong Liang, M.D. Xin Tong Wang, B.S. Yuan Hong, B.N. Ying Jun Yan, M.D. Department of Plastic and Cosmetic Surgery China Meitan General Hospital Beijing, China