Use of Antimicrobial Irrigation and Incidence of Capsular Contracture in Breast Augmentation and Immediate Implant-Based Breast Reconstruction

Capsular contracture (CC) is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Common risk factors of CC include biofilm, surgical site infections, history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Though bacterial contamination of breast protheses is associated with adverse sequelae, there are not universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix, leukotriene inhibitors, surgical techniques, and others. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. The objective of this review was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Disopyramide pharmacokinetics in the elderly after single oral administration

Disopyramide (D) kinetics were studied after single oral dose (200 mg) in ten elderly male patients (mean age: 75.5 yrs) without clinical or laboratory signs of hepatic, renal or cardiac disease, and in six healthy male subjects. They were all non smokers and had not taken alcohol for at least 10 days. Peak plasma concentration and area under the curve (AUCo-oo) were 54% and 51% respectively higher in the elderly group, whereas plasma half life was virtually the same in both groups (about 9 hrs). The major D metabolite, mono-N-desisopropyldisopyramide (MND), showed a tendency towards an increase of AUCo-24 h and T1/2 but did not reach the 5% significance level. Eight of the ten elderly patients but only two of the six young subjects complained of anticholinergic side effects. On the basis of the pharmacokinetic changes observed (and provided that plasma protein binding is unchanged), D oral dose should be reduced by 1/3, without modifying the dosage interval.