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Background Periprosthetic infection (PI) remains a feared complication of implant-based reconstruction (IBR), with reported rates of 10-20% despite multiple prevention techniques. PI leads to patient morbidity and healthcare costs, requiring systemic antibiotics and potentially implant removal. Antibiotic-impregnated bone discs (ABC) have been utilized to prevent infection in orthopedic procedures, but evidence for ABC in IBR is scarce and limited primarily to implant salvage.
Methods Patients underwent two stage IBR with tissue expander (TE) and ABC disc placement after mastectomy. ABC was prepared by adding antibiotics to polymethacrylate bone cement to a total concentration of 2.4 g tobramycin and 3 g vancomycin and forming the compound into discs. These discs were implanted underneath the TE and inserted in the prepectoral plane with complete acellular dermal matrix coverage. Discs were removed at exchange of TE to implant. We evaluated wound complications and need for explantation postoperatively.
Results Sixty-six patients (one hundred and thirteen breasts) were included in the study. Twenty-one (30.3%) patients had unilateral reconstruction, and forty-six (69.7%) had bilateral. Complications included seromas, which were aspirated in 3 patients (2.7%), hematoma in one breast (0.9%), superficial skin or partial flap necrosis treated conservatively in five patients (4.4%), and mastectomy flap necrosis requiring debridement and replacement of TE in three patients (2.7%). Two (1.8%) TE explants of seven (6.2%) were due to infection of the TE.
Conclusion We found a low postoperative complication rate and only two periprosthetic infections with the use of ABC discs in IBR. This technique is a promising modality for reducing morbidity associated with implant-associated infection.
