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7027347 
Journal Article 
An Evaluation of the Effectiveness of Different Techniques for Intraoperative Infiltration of Antibiotics Into Alloplastic Implants for Use in Facial Reconstruction 
Keefe, MS; Keefe, MA; , 
2009 
Yes 
Archives of Facial Plastic Surgery
ISSN: 1521-2491
EISSN: 1538-3660 
AMER MEDICAL ASSOC 
CHICAGO 
246-251 
19620530 
WOS:000268137300005 
Background: Reconstruction in the head and neck can be difficult owing to the size of the defect or characteristics of the tissue that needs to be replaced. Facial wounds or reconstruction sites can be subject to contamination, thereby risking infection of any implanted material even under ideal circumstances. Particular areas of concern are sites where minimizing the bacterial contamination prior to placing an implant is difficult (eg, the oral cavity and internal nose). Reconstruction involves the facial subcutaneous soft tissue and/or bone, and the ideal implant provides support and natural feel, as well as a low risk of infection. The biocompatibility of alloplastic implants depends on the tissue inertness of the implant and the porosity, allowing connective tissue ingrowth, which in turn decreases the susceptibility to infection. Scalafani et al demonstrated that alloplastic implants contaminated prior to fibrovascular ingrowth had a much higher incidence of infection and rejection.Objective: To examine the effectiveness of several techniques for infiltrating antibiotics into alloplastic implants of different porosity using 2 commonly used alloplastic implants, expanded polytetrafluoroethylene (e-PTFE, or GORE-TEX) and porous high-density polyethylene (Medpor).Results: Using an in vitro bacterial growth inhibition model, we found that suction infiltration of the implant with antibiotics was the most effective technique, with a statistically significant advantage over other techniques used. The advantages of the suction impregnation were seen to be most effective using alloplasts with a smaller pore size (20-30 mu m) (P < .001), but there was a statistically significant difference even with implants with a larger pore size (150-200 mu m) (P <. 001).Conclusions: Suction infiltration of antibiotics into porous implants seems to be the most effective method identified using an in vitro testing protocol. Further experiments will be needed to confirm the effectiveness in reducing the perioperative risk of infection in vivo.